Low-income elderly program faces cut
Spokane County’s public mental health system will stop serving at least 600 elderly patients battling illnesses such as Alzheimer’s and depression.
The county’s Regional Support Network will cease funding a Spokane program that serves hundreds of low-income elderly residents by providing care in their homes and by dispatching mental health workers in emergency situations.
The county system has long used federal Medicaid money to finance the program’s $560,000 annual budget, but strict new interpretations of federal law now prohibit the practice, state and county officials said.
“These people need help as much as anyone else,” said Kasey Kramer, the RSN’s director of community services. “It’s just that nobody really seems to be interested in paying for it.”
The Spokane program is the latest cut resulting from a sweeping federal enforcement designed to crack down on the rising cost of Medicaid, the state-federal program that pays for the bulk of Washington’s outpatient mental health costs. As a result of stricter enforcement under the Bush administration, Washington’s mental health system will lose about $41 million in funding annually, experts estimate.
“In years past, we have not been as vigilant in enforcement,” said Rod Haynes, a Seattle spokesman for the Centers for Medicare & Medicaid Services. “The unfortunate reality is that there will be vulnerable populations affected by this.”
This week’s announcement was the latest in a string.
Last year, the county announced that as many as 900 mentally ill people would lose coverage because they were not enrolled in Medicaid. Although the RSN did not provide an exact count, mental health providers later said about 400 people actually lost care.
This summer, the county reported it would stop treating 125 people in emergency situations – meaning their mental illness was so serious they faced hospitalization – unless they qualified for the federal program.
The federal enforcement has shifted the cost of caring for the mentally ill from Medicaid to state programs and small community clinics. Spokane hospitals and the county jail report marked increases in the number of mentally ill in their facilities, as well.
Late Wednesday, the county notified Aging and Long Term Care of Eastern Washington that it would prematurely sever its contract, effective Dec. 31. The elder-care group – a public corporation that serves five counties – signed a one-year contract with the county last spring. The funding change only affects Spokane County.
Nick Beamer, the group’s executive director, said the county had provided no warning that it would end the contract.
“This is a bolt from the blue,” Beamer said. “I don’t know why the RSN is doing this at this time. They have put us in a very precarious situation.”
Beamer said the cuts will also affect a program that transports mentally ill clients to medical appointments, as well as a phone hotline that helps identify at-risk elderly people.
In the past 25 years, the Spokane programs have received national recognition for their work with elderly patients struggling with mental illness, yet trying to remain in independent living. Both the Ford Foundation and the Harvard School for Government honored the group.
“It has nothing to do with the quality of the program,” Kramer said. “It’s unfortunate. It’s about rules limiting what kind of services can be delivered.”
The state’s Mental Health Division reports that other counties across the state are experiencing similar problems. This month, Yakima County’s mental health provider sent letters to 497 clients informing them they were no longer eligible for care.
According to a state official, the state’s Mental Health Division plans to announce a $20 million emergency allocation to continue care for about six months. But to replace the lost Medicaid money permanently, the state would have to increase its current funding about 20 percent, according to a state task force assigned to study the problem.
The task force has come up with a list of “service reduction options,” which include ending outpatient treatment for 8,000 lower-priority Medicaid children, or 2,400 adult Medicaid clients. The reduction would rank the clients based on need, and those with low scores would not be served, according to a task force document posted on its Web site.
The task force also proposed consolidating the number of regional support networks to cut down on administrative costs and revising laws to reduce civil commitments to psychiatric hospitals and jails.
The state’s public mental health system serves about 125,000 low-income people, and officials estimate that as many as one in three are not enrolled in Medicaid. In Spokane County, as many as two-thirds of the mentally ill clients were not enrolled as recently as three years ago – either because they refused to fill out paperwork or failed to meet income requirements.
Yet for more than a decade, the federal government allowed Washington’s public mental health system to spend unused Medicaid dollars on people who did not qualify for the program but nonetheless needed care.