Thousands of mentally ill Washington residents may wind up on the streets, in jail or in their own private hells because of changes to federal funding programs that eliminate counseling and medical treatment.
Unless state legislators step in with more money, people now getting help could face years of suffering, mental health groups warn.
“We’re in a crisis, and it’s only going to get a lot worse,” said Selena Bolotin, director of mental health for Stevens Hospital in Edmonds.
Hundreds in Snohomish County are being denied treatment or moved out of mental health residences because of the funding changes.
Federal Medicaid officials recently decided to enforce Medicaid rules they’ve had on the books for years.
The state Department of Social and Health Services had long used Medicaid money to treat the mentally ill, including outpatients and those living in residential treatment centers.
But Medicaid’s rules say the money must only be spent on Medicaid patients. And psychiatric care homes with Medicaid patients cannot have more than 16 beds.
Medicaid money makes up the bulk of most nonprofit mental health groups’ budgets. Thus, treatment is ending for most non-Medicaid patients the state has been helping with Medicaid money.
More than a dozen beds will have to be eliminated countywide to keep Compass Health’s residential treatment centers qualified for the money.
And a 48-bed Medicaid-only center run by Bridgeways in Everett will switch to treating outpatients exclusively.
The change likely will push more mentally ill people onto city streets, predicted Steve Thompson, Snohomish County corrections director. Some may end up in jail, he said.
Only a small number of mentally ill people are arrested for violent crimes, he said. Most are booked for relatively minor offenses.
A homeless person sleeping on someone’s front lawn could be picked up for trespassing. Someone screaming and refusing to leave a restaurant might be arrested for disturbing the peace.
The jail has three full-time counselors and a part-time nurse to help mentally ill inmates. Their job is not to treat the prisoners, he said.
“This is a detention center, not a rehabilitation center,” Thompson said. “But we’re becoming more and more a default service provider for the mentally ill.”
Even with the counselors, the trauma of being in jail can exacerbate the problems of the mentally ill, said Marysville Police Chief Bob Carden, who sits on Compass’ board.
The funding changes will cost taxpayers more in the long run, he predicted. Taxpayers will not only have to pay the average $62 a day to house the prisoners. They’ll also have to pay for police time to deal with mentally ill people committing minor crimes, Carden said.
“Does it really make a lot of sense,” he asked, “to pay to institutionalize people in jail rather than put money into paying for mental health treatment?”
Fallout for hospitals
Hospital officials worry that people forced from treatment programs will seek help from their psychiatric wards. But hospitals don’t have space for them, said Bolotin of Stevens Hospital.
And both of the state-run psychiatric institutions have eliminated beds so people could get the type of community-based care that’s now being cut back.
Karen Kipling, who runs the regional Volunteers of America crisis line, fears that people no longer getting treatment will deluge the emergency line with calls because they have nowhere else to turn. The group doesn’t have the money to hire more phone counselors.
“It really grieves me to have to go down this road,” said Charles Benjamin, executive director of the North Sound Mental Health Administration.
The nonprofit group distributes Medicaid money to Snohomish, Island, Skagit, San Juan and Whatcom counties.
“It will be a revolving door for non-Medicaid recipients,” Benjamin said. “With no case manager, no counseling and no one to manage their medications, they most likely will not be able to maintain themselves in the community and will keep ending up in the hospital.”
Medicaid is a joint federal-state program. States decide who is eligible for Medicaid, and the federal government must then match the money that the state spends on mental health for Medicaid recipients.
The federal government has never specifically approved Medicaid money to be spent the way Washington has been using it, said Mary Kahn, of the Centers for Medicare and Medicaid Services.
The rules may have been overlooked in the past, but the Bush administration has ordered more scrutiny to assure that states are spending taxpayers’ money as intended, Kahn said.
Medicaid patients will get better care as a result of the changes, she said.
Those wanting to expand coverage for mentally ill people in Washington state should lobby the state Legislature, not the federal government, Kahn said.
“It’s the state’s choice to cut them off, not ours,” Kahn said. “They could fix this in a day, and they’d be in line for big federal dollars if they do that.”
The state has decided that adults must have very low incomes to qualify for Medicaid. For example, an adult living alone must make less than $6,983 a year.
If that was increased, more people would qualify for help, Kahn said.
Steve Norsen, chief of mental health services for the state, said Olympia has been spending Medicaid money on non-Medicaid patients for the past decade, with no complaints from Medicaid.
State officials assumed they had approval to use the money on non-Medicaid recipients, as long as Medicaid patients were served first, Norsen said.
The state has a $33.4 million pot of mental health money, separate from Medicaid, that it can spend any way it wants.
But it hasn’t increased that amount for 12 years because the federal government doesn’t match that money, Norsen said.
Instead, the state has concentrated on its Medicaid spending, which is matched dollar for dollar, he said.
The sudden change caught the state by surprise, he said.
The state is now scrambling to set things right.
State Rep. Eileen Cody, D-Seattle, who heads the House health committee, is helping to lead a task force.
Treating the mentally ill, Cody said, would cost state taxpayers less than paying for the myriad problems that stem from those patients getting sicker.
She plans to push the Legislature to find money to treat mentally ill people despite the state’s big budget hole.
The state has until Jan. 1 to get in step with Medicaid rules.
Health care organizations are already moving patients out of treatment and have stopped accepting new ones.
Bridgeways is gradually shifting its 48 patients out of its Madison House in south Everett.
Most residents are severely disabled and have been there for an average of five years. The group doesn’t believe it’s financially possible to efficiently treat 16 or fewer people at the heavily staffed building, executive director Chuck Roxin said.
Some of the residents are being moved into 16 apartments Bridgeways owns in two Everett buildings. Others will live independently.
Some vacant rooms are being turned into activity areas and counselor offices to house the outpatient services Bridgeways will add to help those who are being displaced.
The goal of Bridgeways and other mental-health groups is to get patients well enough so they can live independently.
But Roxin fears that some Madison House patients aren’t ready.
“It’s better to have people in the community, but this is a very difficult transition for those who are very sick and need a safe haven to stabilize,” he said. “They need to recover their ability to live independently, so this is a very vulnerable period for them.”
Seamar Community Health Centers of Seattle has already cut off treatment to a dozen people from its Everett clinic and about 70 more from its five other outpatient mental health clinics in western Washington.
A third of Seamar’s nearly 200 Everett patients likely will lose psychological counseling, medication or both by the end of the year, said Claudia D’Allegri, behavioral health director for Seamar.
Some may be able to pay the costs themselves, but others might have to choose between getting help or feeding themselves, she said. Even those with health insurance often have policies with limited or no mental health coverage, she said.
Some people without treatment will get sicker and eventually end up at places such as the psychiatric ward at Stevens Hospital, which treats only serious cases.
But Stevens usually has few extra beds and will have to turn people away, said Bolotin, Stevens’ mental health director. And hospital psychiatric wards aren’t intended for long-term patients.
They try to stabilize patients as quickly as possible and transfer them to their homes or to monitored residential facilities.
Patients at Stevens now stay an average of eight days before they’re discharged, Bolotin said.
She worries that hospitals may have to keep patients longer as a result of the Medicaid changes eliminating spaces for them elsewhere in the community.
It’s very important to get mentally ill people who are recovering out of a hospital’s institutional setting, she said.
“When they need it, it’s a godsend,” Bolotin said. “But being in a hospital is not integrating someone with the normal everyday coping skills in a home setting. It’s an emergency situation.”
Reporter David Olson: 425-339-3452 or dolson@heraldnet.com .
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