Health care providers say the state’s decision to defund some Medicaid programs could end up costing the state upward of $150 million in the first year.
The cuts, which impact programs that serve people in crisis and those with severe mental health disorders, could add financial and staffing burdens to local governments, mental health care providers and law enforcement.
The cost
A report by the Idaho Association of Community Providers and the Idaho ACT Coalition said while the reductions will result in an initial savings of roughly $20 million, over time, the cuts could cost more than $150 million in other areas through the increased utilization of emergency services, law enforcement, involuntary psychiatric holds, child welfare programs, and other costs such as management of homeless encampments.
The cuts eliminated the state’s Assertive Community Treatment, or ACT program; in-home residential treatment and Partial Hospitalization Programs; Early Serious Mental Illness teams; and peer support programs.
“By the time you calculate increases in predictable (state program) usage, hospital usage,” said Ric Boyce, co-director of the Idaho Association of Community Providers, “that’s gonna cost $150 million to $180 million, on the very conservative end.”
In the state’s Region II health district, which includes Nez Perce, Latah, Clearwater, Lewis and Idaho counties, IACP predicted the cuts could result in $12 million to $16 million in costs for local governments annually.
Those cuts are part of a 4% reduction for Medicaid provider pay rates, part of an effort to shore up the state’s budget shortfall estimated to be around $58 million, according to the Idaho Legislative Services Office.
That shortfall includes a revenue loss of $253 million in tax cuts that largely benefit Idaho’s wealthiest residents, according to the Idaho Center for Fiscal Policy, as well as the added cost of $675,000 in tax credits to reimburse families for nonpublic education.
Local impact
Sara Bennett is the owner of Riverside Recovery, which has offices in Lewiston and Orofino. For more than a year, her team administered the regional ACT program. Previously, ACT was administered by the state directly.
ACT programs operate nationwide and are designed to offer behavioral health support for people with severe mental illness for whom traditional mental health services haven’t worked, Bennett said. They’ve been shown to significantly reduce hospitalization.
Patients include people with psychotic disorders such as schizophrenia and schizoaffective disorder, as well as people with severe bipolar disorder and major depression.
“ACT is that kind of aggressive outreach,” she said. “Helping engage that individual in the community or in the setting that they’re in, and helping them stabilize within that environment.”
Bennett and her team served about 40 people in the region through ACT. Statewide, the program served around 400 individuals.
But this week, those patients are no longer receiving the treatment they’re used to.
The budget cuts, which providers were told would “unbundle” services previously funded as a package, effectively eliminates the program, Bennett said. For instance, the ACT team worked with a nurse who could administer injectable medication.
“With what they call ‘unbundling’ of ACT, nursing isn’t even a billable service,” Bennett said.
The decision to cut programs happened without feedback from providers or the public, which Bennett, Boyce, and other clinicians noted in a lawsuit against the Department of Health and Welfare that was dismissed.
A second class-action lawsuit was filed in late November on behalf of patients in the ACT program.
Bennett said the only option left for patients who were on ACT are traditional mental health services, which are less effective. Bennett said patients, some of whom have relied on ACT for over 20 years, are worried.
“This is the lifeline that they know has kept them well,” she said. “They’re very scared and worried about what that’s gonna look like for them and how they’re gonna get the support if they’re struggling.”
Boyce said he anticipates as many as half of the roughly 400 patients statewide who were served by ACT may drop off in the transition to outpatient mental health counseling.
“These are people who can barely answer their door consistently to us,” he said. “Realistically, these (unbundled services) are not the appropriate services. They’re not the evidence-based services that will keep those individuals out of hospitals, out of jails, out of homelessness.”
Tom Lamar, Latah County commissioner and former vice chairperson of the Region II Behavioral Health Board, said he’s expecting an added burden on local crisis and recovery centers, mental health providers, nonprofits and law enforcement.
Lamar said that in cutting services bundled under Medicare, the state Legislature shifted the responsibility and cost to local programs.
“They really need to develop a more mature view of the costs of providing services at the state and local levels,” Lamar said. “Counties are a subdivision of the state of Idaho, according to the (state) constitution. And they don’t act like it.”
In a letter sent to Gov. Brad Little and state lawmakers on Dec. 1, the Idaho Sheriffs’ Association wrote that elimination of services would cause an increase in call volumes, involuntary holds, incarceration, civil and criminal court cases, and negative outcomes for community members.
“County sheriffs’ offices, especially rural agencies, already operate with thin margins,” the letter said. “The loss of these stabilization programs will not reduce the overall cost to the State of Idaho. Instead, it will shift those costs directly onto county budgets, jails, E.M.S. agencies, and local taxpayers.”
In Region 2, the Nez Perce county jail would likely see an increase of inmates from both inside and outside of county lines.
Latah County in June transitioned its jail to a court holding and booking facility after an assessment found the need for extensive updates, according to the Lewiston Tribune. Most inmates there are now transferred to Nez Perce county jail, Lamar said.
Bennett said she hopes legislators will add those programs back next year, ensconced in state law.
“These are the individuals with the highest needs, and this is the only evidence-based treatment that we offer,” she said.
The Region II Behavioral Health Board will meet Thursday with plans to talk to local legislators and their representatives.
