Board OKs reductions that will limit mental health care access

Thousands of low-income Oklahomans with mental illnesses and substance use disorders will have less access to the care they need, a result of cuts approved Thursday at a special state Medicaid board meeting.

The Oklahoma Health Care Authority board approved cuts Thursday that limit how much therapy Medicaid members can receive. The board also approved provider rate cuts to behavioral health professionals.

The cuts are the Oklahoma Department of Mental Health and Substance Abuse Services’ attempt to balance the agency’s budget amid the state budget crisis.

As a result of the two state revenue

failures, the agency has cut almost $23 million from its budget over the past few months. Agency leaders do not know whether the state mental health department will see budget cuts for the next fiscal year, which begins July 1, or how big those cuts would be.

Oklahoma has some of the highest rates of mental illness and addiction in the nation, yet ranks among the bottom five states for money spent on statefunded services.

“I wish that I was here because we were presenting an increase to behavioral health services in the state of Oklahoma,” said Terri White, state mental health commissioner, during the board meeting. “The fact is — before these cuts, we could only serve one out of every three individuals that needed help. This widens that gap, which is tragic. These aren’t cuts that any of us want to put in place.”

The Oklahoma Health Care Authority administers much of the state Medicaid program, known as SoonerCare, but for about four years, the state mental health department has overseen Medicaid dollars used for behavioral health. Because of this arrangement, the authority’s board still votes on Medicaid-related cuts that the mental health department proposes.

At Thursday’s meeting, independent counselors and therapists expressed concerns during public comment about the proposed 30 percent provider rate cut, saying that independent practitioners were being targeted.

Some of this sentiment dates back to earlier this year, when the state mental health department proposed, as a budget-saving measure, to no longer pay independent counselors to treat Medicaid patients. Gov. Mary Fallin rejected the plan, saying the move would affect thousands of vulnerable children.

Heather Askew, an independent therapist at the Halo Project, said during the meeting that the counselors where she works are trained to treat children with attachment issues, with many foster and adopted children coming through their doors.

Askew said the Halo Project had no issues with community mental health centers but wanted to see fairness in the proposed cuts.

“We are not antiagency,” Askew said. “We believe the best way forward in the budget is to shoulder the burden together. Yet, it’s deeply concerning that independents continue to be targeted, first for outright elimination, and now elimination in this way.”

Richard DeSirey, managing partner of Tulsa-based A New Way Counseling Center, said when the state mental health agency chose which cuts it would make, it didn’t consider how the cuts would affect minority communities or families.

“Our system for kids is supposed to be child-centered,” he said. “It’s community mental health center driven.”

State leaders say they will save the state money through the cuts but lose federal matching dollars as a result.

The board approved provider rate cuts at the meeting that include:

•A 3 percent provider rate cut to freestanding psychiatric hospitals. Total estimated savings for current fiscal year: $57,249, including $22,333 in state dollars. Estimated savings for next fiscal year: $343,501, including $134,000 in state savings.

•A 10 percent provider rate cut to independent psychologists. Total estimated savings for current fiscal year: $125,608, including $49,000 in state dollars. Total estimated savings next fiscal year: $751,089, including $293,000 in state dollars.

•A 10 percent provider rate cut to behavioral health licensure candidates in outpatient behavioral health clinics. Total estimated savings for current fiscal year: $1.3 million, including $537,418 in state dollars. Total estimated savings for next fiscal year: $8.2 million, including $3.2 in state dollars.

•15 percent provider rate cut for residential psychiatric services. Total estimated savings this fiscal year: $2.2 million, including $875,000 in state dollars. Total estimated savings for next fiscal year: $13.3 million, including $5.2 million in state dollars.

•30 percent provider rate cut to independent licensed behavioral health practitioners, including private practice counselors and therapists. Total estimated savings for current fiscal year: $889,005, including $346,801 in state money. Total estimated savings for next fiscal year: $5.3 million, including $2 million in state dollars.

Meanwhile, community mental health center leaders said the board should approve the proposed cuts because few services were left to cut, and the Legislature hasn’t shown interest in funding mental health at the capacity the system needs.

“I’m at the Capitol a lot ... and the words that I keep hearing are ‘catastrophic,’ ‘dire,’ ‘severe,’ and if’s and but’s, but there’s no clear plan and no unified plan right down the street to make a decision,” said Joy Sloan, Green Country Behavioral Health Services CEO, referencing the Capitol just south of the authority’s building. “They don’t want to make that hard decision. They aren’t prepared to make that hard decision.”

Verna Foust, Red Rock Behavioral Health Services CEO, said her agency, which serves more than 10,000 people each year, has seen a decrease of hundreds of thousands of dollars over the past few years as the mental health department cut its budget to ensure it presented a balanced budget to the Legislature.

Foust said she still supported the department, albeit disheartened by the cuts, because the department was trying to make the cuts that could save the most dollars but affect the least number of people.

“I believe our overarching goal is to preserve the safety net services for the most vulnerable population of our state, and I believe the Health Care Authority and the Oklahoma Department of Mental Health and Substance Abuse Services have that goal in mind as they’re forced to make these very difficult decisions,” Foust said.

Commissioner White said community mental health centers have borne the brunt of cuts recently, whereas independent practitioners have largely seen no rate cuts.

Plus, the authority board approved cuts to the amount of therapy that Medicaid members can receive, which will affect community mental health centers, White said.

“The idea that these rate cuts have been targeted, or inequitably borne by this group of independent practitioners is absolutely incorrect,” White said. “Besides the last two years of cut that have been borne by the agencies — community mental health (centers), substance abuse providers and private mental health agencies — in addition, this year, besides the rate cuts that affected everyone, there was an $8.3 million ripped out of the safety net in contracts of those agencies.”