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The
crisis facing Fairfield County's Alcohol, Drug Addiction and Mental Health
Board is a direct result of its Medicaid expenditures -- the bottom line
being that while those needing care continue to increase along with the
increase in costs, the funds aren't.
"Our
situation is more severe because of the Medicaid match problem," said
Orman Hall, executive director of the board. "If you look at our overall
expenditures it has grown tremendously, and we have no ability to control
those Medicaid expenditures."
The
Medicaid program was created in 1965 and pays for a broad range of acute
and long-term mental health care services for a segment of the low-income
population.
Mental
health is the only major Medicaid benefit where local governments pay the
bills.
When
giving testimony before Senate Finance Committee in May -- in regards to
the budget bill, Michael F. Hogan, director of the Ohio Department of
Mental Health made this point.
"The
fact that mental health is the only major Medicaid benefit where local
government pays the bills is a challenge for us," Hogan said. "When
Medicaid costs rise in mental health, and overall Medicaid costs in Ohio
indirectly reduce resources available for other programs, mental health
care for the working poor gets cut. This has gone on for several years; it
will accelerate in this budget."
This is
exactly what's happening in Fairfield County, Hall said.
"If
you're Medicaid eligible and you show up at an agency that has a contract
with ADAMH and we have any available funds in our budget, we have to pay
for those services before we pay for anything else," Hall said. "We don't
have enough to pay for dramatic increases being billed to our board."
The
board has six contracting agencies: New Horizons, Mid-Ohio Psychological
Services, The Recovery Center, The Lighthouse, the Fairfield Mental Health
Consumer Group / Our Place, and Fairfield Medical Center.
In the
last fiscal year -- July 1, 2002 to June 30, 2003 -- Medicaid billing for
four of the six agencies was more than $3.6 million. This total was up
23.7 percent from the previous fiscal year.
The
Fairfield Mental Health Consumer Group / Our Place and FMC don't bill for
Medicaid services and therefore aren't included in the totals.
There
are 2,056 Medicaid clients and 1,353 non-Medicaid clients in the county.
This population makes up 3 percent of the total county population.
There
are two primary reasons why Medicaid costs continue to rise, said Sam
Hibbs, spokesman for the Ohio Department of Mental Health.
"There
is increased enrollment -- more people become eligible during an economic
downturn," Hibbs said. "Like all medical costs, Medicaid costs are rising
faster than inflation, in large part due to increased use of prescription
drugs and increased costs for those drugs and also because a higher
percentage of services is being billed to Medicaid."
One
advantage to Medicaid is that the local board pays 41 percent and the
other 59 percent is paid by the federal government, Hall said.
"It is
kind of a double-edged sword," Hall said. "Some aspects of Medicaid are
very good and some are very bad."
The
board also is responsible for residents -- including children in foster
and adoptive care, who may live in another county.
"If they
are a Fairfield County resident and need mental health services and have
Medicaid, we are billed and responsible to pay for those services," Hall
said.
Medicaid
billing for out of county expenses was $532,469 in FY 2003, up from
$460,652 in FY 2002.
Since
the levy failure in last November's general election, the board has made
more than $600,000 in budget reductions which in turn stream down to the
contracting agencies, who then make cuts on their end.
Since
agencies can't cut Medicaid services, reductions come from non-Medicaid
and discretionary programs, which affects those who aren't Medicaid
eligible.
"It's
conceivable but not likely that if Medicaid billing trends continue --
that if you were suicidal, have a serious mental health or drug problem --
and you don't have a Medicaid card, agencies would have to turn you away
because they can't treat you, because there's no money," Hall said.
"There's a lot of working poor people in this county who don't have
Medicaid and would be turned away. A lot of these people are being
undertreated now. Most people eventually get in and receive services, but
if patterns continue, it is possible that our agencies won't be able to
treat them."
At this
point, there is no way to cap Medicaid.
"Capping
Medicaid under federal rules would mean implementing managed care which is
complex, costly and creates problems of its own," Hibbs said. "More
important, capping costs is not desirable, because there is a need for the
care being provided."
This
makes levy dollars even more of a necessity, Hibbs said.
"I think
states subsidize mental health to a point," he said. "Local levy money is
very crucial and it's being eaten up to pay for Medicaid match. The system
overall has been flat-funded for a decade or so and there's no more money
to be squeezed out of the state system. Local boards are really feeling
the crunch now."
Originally published Tuesday, August 12, 2003 |
