State Budget Cuts: Community Impact Series - Unintended Consequences

Mar 06, 2018

By MBPC Staff

Unintended Consequences. This blog is the third in a series to bring to light the real-life impacts of the state budget cuts. We began this series with a post about cuts within the Department of Health and Human Services (DPHHS), which resulted in the closure of more than half of the state’s outreach offices. Next, we focused on the deep reductions to targeted case management and mental health services. In subsequent blogs, we will cover cuts to developmental disability services and substance use disorder treatment. Here we present a broad overview of the developing unintended consequences and expensive cost-shifts as a result of these deep budget cuts.  Prior to the special session, actions by the legislature resulted in about $14 million in cuts to the rates paid to health care providers who accept Medicaid patients. These cuts have taken a toll on service providers’ ability to provide care for Medicaid patients, including adults and children with mental health needs. On top of cuts made during the regular session, the special session resulted in an additional $18 million cut from targeted case management for children and adults with mental health needs, substance use disorders, and developmental disabilities. The cuts have left providers across the state reeling. They were already struggling to meet the demand, but the cuts and rule changes will make it impossible to keep their doors open or provide services at full capacity. These are the nonprofit organizations that help those with physical or developmental disabilities remain in their homes, instead of being institutionalized. They allow older adults to receive help in their own homes instead of a nursing home. These organizations provide crisis management, run jail diversion programs, offer family support and myriad other programs that keep people employed, housed, out of jail, and with their families. Without community care, the number of people in jails, the state prison, and the state mental hospital will increase. There will be more homelessness, more alcohol- and drug-related crime, and more children removed from their families and into foster care. There is no shortage of service providers, educators, and public safety officers who are worried about this nightmare. Kari Auclair, the program manager of the West House Crisis Facility in Hamilton, told the Ravalli Republic: “What I foresee is our jail will be over capacity. Our ER will be inundated. Our crisis center will be inundated. Those folks who are living on their own, who may be homeless, who don’t have medications or know how to get them — I don’t know what will happen to them.” County sheriffs are concerned the pressure that these cuts to mental health services will place on jails and their police force. Flathead County Sheriff Chuck Curry told the Flathead Beacon, “Any time we start impacting community-based mental health services, it certainly impacts the jail population…Unfortunately, if we’re not treating them in the community, they often do wind up in a facility such as ours.” The Missoula County Attorney’s Office is equally concerned about lack of case management for Montanans with mental illness and particularly on Missoula's homeless population. Jordan Kilby, the attorney in the civil division of the county attorney’s office, handles involuntary commitment cases and knows first-hand that case managers are important to keep people out of the prison system and state psychiatric hospital. The medical directors at our community mental health centers across the state have loudly opposed the state’s cuts to behavioral health services. Substance use disorders and mental health conditions overlap 80 percent of the time. According to Attorney General Tim Fox, one in 10 Montanans is dependent on or abusing drugs or alcohol. Some people referred to the state budget cuts as “savings.” But the true cost will shift to other areas: public safety, the state mental hospital, the prison system, and our public schools. These cuts will also have long term financial consequences for local, county, and state budgets. The state legislature could have supported common-sense revenue measures in order to prevent these deep cuts to health and human services. But instead they opted to create more hardship for Montanans who rely on case managers, community-based care, and counselors to live self-sufficient, stable, and productive lives. At MBPC, we know that Montana can choose another path. We can bring in new revenue that makes our tax system fairer. We can adequately invest in the public services that educate our children, keep our communities safe, and provide much-needed health care to our neighbors.