Editor’s note: This a three-part series on how cuts in state Medicaid reimbursements are affecting local health organizations. Look for installments two and three on the next two Saturdays.

By Cristina Janney

Newton Kansan

As of Jan. 1, the state cut 10 percent of all Medicaid reimbursements.

Locally that means health agencies are having to provide the same services with hundreds of thousands of dollars less than last year.

For those who provide services to the mentally ill, physically sick and developmentally disabled, health systems in the state are stretched to the point of breaking.

Jessie Kaye, Prairie View president and CEO, sat down with The Newton Kansan to explain how the cuts are affecting the state’s mental-health system.

Budget cuts

Locally, Prairie View is the single agency that is losing the most Medicaid money.

As a community mental health center, Prairie View is obligated to accept all patients regardless of their ability to pay.

About 3,000 or 20 percent of Prairie View’s patients are covered by Medicaid.

“Many of these have always had a copay, according to our sliding-fee scale,” said Jessie Kaye, Prairie View CEO. “We are not increasing their copay as a result of the rate cut; however, we are encouraging payment of these amounts a bit more assertively than we have in the past. We just don't have the resources to bear that difference.”

Prairie View will lose an estimated $750,000 this year as a result of the Medicaid cuts. That is about 6 percent of the organization’s budget.

Prairie View has lost an additional $115,000 in state grants to provide services to the uninsured and underinsured.

After the state starting closing state hospitals in favor of community-based care, mental health funding stayed consistent for about 15 years but then took a nose dive, Kaye said. During the last three years, mental-health funding has been cut by 65 percent.

“The state has had increasing expectations over the last several years,” Kaye said. “During that same period of time, funding has been repeatedly cut. We can’t continue on this path without reaching a tragic outcome.”

Accessing services

As is the case in much of the health services industry, personnel make up a high percentage of Prairie View’s budget — about 82 percent.

Kaye said Prairie View has tried to preserve its workforce, but some cuts have been made.

“While we are striving to minimize the impact of these cuts on our patients and our staff, we are having to make reductions. We have eliminated two positions and are holding several more open,” Kaye said. “We’ve reduced the hours of another 10 employees, and we’ve had to make some changes to employee benefits.”

These cuts have meant clients have seen changes in accessibility of services, Kaye said.

Prairie View does not have a waiting list for services, but clients have had to wait longer for appointments and wait longer between appointments because of the funding cuts.

Prairie View is limiting the professional development assistance it provides, which creates problems since its clinical staff members have to complete continuing education requirements to maintain their professional credentials and remain eligible to practice.

Kaye said the state also has requested more paperwork and documentation of treatment outcomes, which puts a greater strain on staff and resources.

Hours also have been cut at a few locations to reduce overhead costs.

“We reduce overhead costs, but that makes us less accessible to our clients,” Kaye said.

Community care verses state

hospitals

Many members of the staff have served on state and local boards aimed at prevention and improving services for the mentally ill.

“We have had to say no to that,” Kaye said. “We can’t afford to have them out of the office. We need them here seeing clients.”

On a personal level, Prairie View staff have traditionally offered clients with severe and persistent mental illness with advocacy and assistance with issues involving housing, personal health and hygiene and finances.

Time and budget restraints mean these services no longer can be offered.

Prairie View also is having more difficulty covering crisises, which means patients in the custody or care of the emergency room or law enforcement have to wait longer to be evaluated.

This ties up valuable community resources, and can be stressful for the patients, Kaye said.

Without adequate community support, the most severely mentally ill are ending up in state hospitals.

Community services cost about $20 a day, and it costs $400 a day to care for a mentally ill patient in a state hospital, Kaye said.

The state hospitals also are overpopulated.

Because of space limitations, rooms in the state hospitals meant for one or two patients are now housing two or three patients, she said.

Kaye said these are not patients that can be turned away. They may be suicidal, homicidal or delusion and be a threat to themselves or others.

Although no one has been turned away from the state institutions, the state is discouraging community health centers from sending patients, Kaye said.

“What has happened is that the state has continued to reduce the funding to provide services in the community — intended to keep folks at home rather than in state institutions,” she said. “Now, that funding continues to be taken away, patients are experiencing more crises and less access to community- based interventions. So, more seriously ill patients are needing hospitalization. Consequently, the state then has the burden of providing more expensive inpatient care, taking patients away from their homes and families. This isn’t a good solution!”

Stretched to

the limit

Despite its challenges, Prairie View is doing better than some of its peer community mental health centers.

“Prairie View is fortunate because we can maintain a bit more strength and stability than some of our colleagues (community mental health centers) because of our more diverse programming -— other services that are not funded by Medicaid or state grants. However, it’s not a great time to be in the mental-health business,” Kaye said.

The agency continues to see more patients who qualify for Medicaid, with bad debt and who have no insurance.

What would more cuts do?

Kaye said she did not know what might happen if Prairie View and the state mental-health system was hit by more cuts.

“Our staff says that we already are at (the limit),” Kaye said. “We are stretched as tight as we can go. ... We are at a place now that any more reductions are going to impact people in a negative way.”