What happens if Medicaid is cut back?
NYS Office of Mental Health (OMH) is going gangbusters creating a new image for community mental health in our county and all over the state. It's restructuring the mental health clinics (new rates for Ellis mental health clinic) and converting continuing treatment centers, social clubs and intensive case management into PROS model programs (personal recovery oriented services), among other things.
It's trying to pull together mental health and substance abuse services along with general health care in the same locality under one roof in what's called a “medical home.” This hasn't gotten too far with the mental health clinic and substance abuse programs here, but it will come. It's considered the wave of the future—like one-stop shopping.
Of course, you still need dental care and children's health services on the same campus, don't you? Ellis's health center on McClellan Street has moved part way in that direction.
The state OMH wants to move patients out of nursing homes and state hospitals like Capital District Psychiatric Center, into homes and apartments. The community housing would be run by not for profit providers like RSS and Mohawk Opportunities in our area. Those movements are underway locally with requests for proposals (RFPs) about to be issued by the counties to the housing providers to open 11 supported apartments in Schenectady and more than 20 in Albany County, from what we hear.
Aside from the apartment growth, reshaping of the mental health landscape is costly and questionable as to the merits. It's coming at a time when there isn't any more of the usual state money for expansion. The not for profit hospitals and agencies are taking in clients with high needs, some of whom do not have health insurance. Family and child counseling agencies have been tightening their belts for some time with the tough economic situation. Yet the state finds the money to spend where it wants.
The main funder, of course, is Medicaid, the cash cow that the Office of Mental Health is willing to drain as fully as imaginable. Most of its mental health aid to communities now comes from Medicaid (50-50 with the feds), not out of state revenues. Programs called Community Support Services and Reinvestment, entirely state funded, are drying up or gone. From what we gather the big providers depending on Medicaid, like Hometown Health, Ellis Hospital and Northeast Family and Child Society, are hanging on. Others, like Catholic Charities, Carver and Family and Child Service of Schenectady, if they can't charge Medicaid, may be worse off.
Closing Collage social club and converting it and Continuing Treatment to PROS will cost more than present programs but Medicaid will now pick up the bill. A clubhouse has closed in Saratoga Springs but it has not been replaced. In Albany County the state wants to consolidate mental health services--the social club, a drop in center, day services and work programs are affected.
New reimbursement rates for outpatient mental health clinics are designed to make these operations more attractive to sponsors like Ellis, while they cost more. And the state is stimulating more patient care in the home with more generous stipends to caregivers. The promoters think patients can get cheaper care at home than in a hospital but there's no proof the patients won't be back on the inside if care isn't sufficient.
Moreover, the state and federal governments are going to spend billions of dollars to convert record keeping systems in hospitals, clinics, labs and doctors offices to electronic systems. These, they say, will speed decisions about patient care and tie in all the doctors and agencies so they can better manage care. It's already upset the traditional way that nurses and social workers do their jobs and there are big questions about confidentiality of records.
The state is willing to change patterns of care in community mental health on the grounds these programs haven't worked well enough to achieve recovery of patients. There simply isn't proof, however, that their new ideas will work better for people with serious mental illness. For the most impaired it is simply a gamble.
Medicaid facing the axe
Meanwhile, cost of psychiatric care is said to be the fastest rising sector within Medicaid spending and the politicians are aware of this. As a state we have a particularly high population of patients with psychiatric illness on Medicaid. And NYS pays more per patient than other states for its Medicaid coverage.
New York's Republican governor candidate Carl Paladino says he'll take an axe to Medicaid and chop it back 40 percent. Andrew Cuomo, his Democrat opponent, also pledges to halt the hemorrhaging of Medicaid spending. We heard a similar tune in a recent debate here between Senator Hugh Farley and county legislator Susan Savage.
How can reforms in mental health care keep going if Medicaid is cut? “That's the million dollar question,” says Darin Samaha, director of the county Office of Community Services. (Roy Neville)