Kaiser Health Policy Report Rounds Up State Action to Shift Mentally Ill to Community- and Home-Based Settings
A number of states are attempting to move mentally ill patients from state facilities into community-based treatment. The following briefly summarizes some of the latest proposals.
- Arkansas: Less than one day after Gov. Mike Huckabee (R) announced plans to cut $20 million from the state Department of Human Services, a measure (HB 1838) that would increase payments to community mental health centers by $3 million each year was defeated in a state House subcommittee. The bill would have earmarked a minimum of $11.5 million per year in state funding for the centers (Arkansas Democrat-Gazette, 4/5).
- Montana: With the state mental health program running a $17 million shortfall last year, the Department of Public Health and Human Services plans on moving mental health care from the current fee-for-service system to a system of regional agencies, which will manage funding and treatment for area patients. The Billings Gazette reports that the state Legislature plans to enact "broad guidelines" on how to structure the system, but will leave the "working details" to Gov. Judy Martz's (R) administration. In 1999, the state revoked a state-private contract with Magellan Behavioral Health of Maryland after complaints about "bad treatment decision[s]" (McLaughlin, Billings Gazette, 3/13).
- Oklahoma: A pilot program is being tested in Tulsa and Ponca City that links various community services to children with "severe emotional problems" and provides care "right where [it is] needed." Called "Systems of Care," the program relies solely on charity funding, but is managed by the state Department of Mental Health. Services include home case management, respite care and purchasing household necessities for families in the program (Tulsa World, 3/31).
- Washington: To move mentally ill patients out of state hospitals and back to local communities, the state Senate budget includes a proposal to spend $5.7 million to expand community services, while closing four wards at Western and Eastern state hospitals over the next two years. The plan is a "scaled down" version of Gov. Gary Locke's (D) plan, which would have closed 15 wards. The Department of Social and Health Services is researching the Senate plan, as it is unknown whether it provides adequate funding for community services (Cook, AP/Tacoma News Tribune, 3/29).
- West Virginia: The federal Substance Abuse and Mental Health Services Administration has awarded West Virginia a six-year, $6 million grant to provide services for mentally ill children at home and at school. The program, called the Mountain State Family Alliance, links mental health professionals with parents to provide treatment before children require treatment at institutions. In addition, the program provides respite care (Miller, Charleston Gazette, 3/26).
Lawsuits and Parity
In other mental health news, advocates are "pleased" that West Virginia legislators have advanced a bill (HB 2601) through committee that would require insurance plans to cover "serious mental illness" the same as physical illness. While the parity bill covers a variety of illnesses, including ADHD and schizophrenia, it does not include tobacco or caffeine addiction. In addition, custodial care, residential care or school care is not addressed by the legislation (Miller, Charleston Gazette, 4/4). Meanwhile in Colorado, a judge fined the state $1.4 million for failing to provide "adequate housing and services" for the chronically mentally ill in Denver. Finding the state in contempt, District Court Judge Morris Hoffman gave the state 45 days to pay the fine and said there would be additional fines for "each day services aren't provided." In addition, he ordered the state to "fully staff" housing facilities for the mentally ill and develop a plan to track those needing services. The state "may challenge" parts of the court order (Pankratz, Denver Post, 4/3).
