Legislative mental health panel: We agree, but not on funding

Thomas Jensen had heard enough.

Jensen is administrative director of Ashland’s Memorial Medical Center, which serves an area of some 10 counties in the state’s northwest corner.

After six hours of discussing issues, exchanging ideas and best practices, and showing support for fellow mental health practitioners and administrators, he’d listened for another hour to a panel of three Republicans and two Democrats on a legislative panel at the Wisconsin Mental Health Summit at St. Norbert College in De Pere.

Jensen was eager to participate in the question-and-answer session, and he pointed a finger toward the dais.

Rep. Jim Steineke, R-Kaukauna, left minutes earlier for an appointment in his district, leaving: Sen. Dave Hansen, D-Green Bay; Rep. Gordon Hintz, D-Oshkosh; Rep. John Nygren, R-Marinette; and Rep. Paul Tittl, R-Manitowoc, to hear Jensen’s plea.

“The hospital that I come from is a critical-access hospital, and we’ve been very successful within the past few years in maintaining our behavioral health facility,” Jensen said.

“Today, I lost $8,000 in that facility. (Earlier) this week, I’ve lost $40,000. By the end of the week, I’ll have lost $50,000 by running that behavioral health unit. A (potential) $2.8 million loss — on 10 beds — to keep this place going, plus an outpatient clinic.

“I have a responsibility to continue to control my costs. And you have a responsibility … to continue to pay for those services up there. If we go down, there is nothing for 100 miles to care for those citizens up there.

“I don’t give a damn how you figure it out. But you’ve got to figure it out. You’ve got to figure it out.”

The audience, including dozens of mental health professionals, applauded. The day-long conference was hosted by the Medical College of Wisconsin.

Much of the panel’s discussion devolved into a back-and-forth on the merits of Medicaid expansion in Wisconsin. Thirty-seven states have accepted that expansion, but Wisconsin has not.

Medicaid expansion would provide coverage to everyone with household incomes at or below 138 percent of the federal poverty level.

Democratic Gov. Tony Evers’ budget proposal calls for acceptance of the expansion, but legislative Republicans are firmly opposed. Evers also has identified mental health care as a priority in the next fiscal year, seeking to add $25 million per budget year to efforts, on top of the additional $3 million per year specified in the budget of former Gov. Scott Walker, a Republican.

While the panel agreed on the need to address issues of opioids, meth and other drug addiction, plus access to mental health treatment for youths, elderly and rural populations, common ground on funding for those initiatives was predictably lacking.

“I don’t see Medicaid expansion happening, as proposed in this budget,” said Nygren, co-chair of the Legislature’s Joint Finance Committee.

“However, there are pieces of the governor’s proposal, directly focused on things such as ‘hub-and-spoke’ — obviously, it’s something that we have actually passed — and the Hope Agenda bills to develop the delivery model for additional (treatment),’’ Nygren said “Really, all the other proposals that he has laid out in his budget we are supportive of. It comes down to how they’re paid for; it comes down to the levels of funding.”

Nygren reminded the audience that during Walker’s tenure, support increased for areas of mental health treatment, including school-based programs. Still, he noted, challenges occur, including insurance coverage issues for those not on a provider’s network.

“You have to be careful how it’s implemented, and how it’s delivering on the intent,” Nygren said, explaining that a constituent told him of a school system that provided counseling services through one local provider but that the family’s coverage was in a different network. “If we’re going to do these types of school-based things, and I think we should, we should make sure that there’s no difference and that it’s accessible, regardless of their insurance level. And I think we can do that without necessarily expanding Medicaid.”

Hintz, the Assembly minority leader, said at some point, a financial investment is needed.

“You do need real resources to invest,” he said. “I’m not giving up. I think Medicaid expansion has been kind of wrapped up in politics, because it came out of the Affordable Care Act, but 37 states have taken it. …

“Financially, it makes sense because it allows us to increase reimbursement, which we know is low and which will help all providers. It helps us free up some dollars to be able to do $69 million into noninstitutional mental and behavioral health services.”

“I’m going to leave the door open on the best way to get to ‘yes,’” Hintz said, “but (Medicaid expansion) makes sense from a resource standpoint, from an access standpoint and from an investment standpoint.”

In supporting Evers’ plan, Hansen said Medicaid is “our right, our obligation and our money that should be used for mental health and a lot of other things for people who really, really need it. … I’m just disappointed that Joint Finance does seem to understand. That’s our money, and we should be taking it.”

But Steineke, the No. 2 Republican in the state Assembly, said: “We’re $22 trillion in debt. The federal government doesn’t have any money.”

Steineke said that while much attention will be paid to the differences between political parties, there are many areas of agreement. “I think you’ll see there are more areas where we agree than where we disagree,” he said.

Hansen is the author of a mental health parity law that demands equal coverage for mental health issues and other physical illnesses. “Depression, bipolar, bullying, all of those things play into it,” he said. “Mental health has to be treated like any other illness. It’s the real deal, and when we start recognizing that, we’re going to be a better state and a better country.”

Many of Tittl’s comments focused on “reducing the stigma” associated with those with mental health illnesses. “We need to embrace the family that is having the mental health crisis,” Tittl said. “We need to engage, and I call on all people — not just professionals, but our friends, our families and our faith-based organizations — to reach out and embrace that person who’s having a struggle with mental health.”

Throughout the panel discussion, other issues — staffing, physical accessibility, early intervention and more — were addressed, but the talk eventually circled back to Medicaid expansion.

After the panel discussion, Jensen faced a five-hour drive home. His hospital is independently owned.

“The next hospital is Rhinelander, 100 miles away, and then we’re down in Wausau and Eau Claire. So, we’re it,” he said in an interview.

Last year, Memorial Medical Center lured a psychiatrist from Rhinelander to Ashland with the promise of local ownership. “It’s not corporate medicine,” Jensen said. “It’s not somebody from a remote central office telling him what his productivity is going to be.”

Jensen spoke of his hospital’s commitment to providing behavioral health care to children in an on-campus building, at a cost of roughly $60,000. “The reimbursements per day will range from $42 to over $800,” he said. “Unfortunately, the lower side is the predominant payer — $42 a day. And it takes three staff members; it’s very staff-intensive because these are little kids.

“And we have a board of directors and a community that is very supportive of it. But something’s going to break. Something’s going to break.”

See reporting on an earlier Medicaid expansion discussion at a WisPolitics.com event in Wauwatosa: http://wisbusiness.com/index.iml?Article=393775


— By Dan Flannery

For WisBusiness.com