Governor Sam Brownback today released his proposal for a new round of $72M in cuts and revenue generation to take a stab at the now $400 million dollar shortfall. http://m.cjonline.com/news/state/2015-04-23/gov-sam-brownback-unveils-72-million-spending-changes-light-400-million#gsc.tab=0
Gov. Sam Brownback submitted a budget amendment to the Legislature on Thursday to reduce state general fund expenditures by $72 million and ease the burden of producing balanced budgets in the next two fiscal years.
Significant amongst these changes will be:
- * A Reduction in Bond Service debt for the Manhattan, Kansas based Agro Defense facility, from $16M paid per year to $10M per year a cut of $12M.
- *~$60M hit toward medicaid receiving hospitals.
http://m.cjonline.com/news/state/2015-04-23/gov-sam-brownback-unveils-72-million-spending-changes-light-400-million#gsc.tab=0
Brownback also proposed raising $18 million annually by increasing a fee charged Kansas hospitals to guarantee higher Medicaid reimbursement rates to hospitals, pharmacists, doctors and dentists. The current assessment is 1.83 percent of net inpatient operating revenue, but the governor recommended the rate rise to 2.55 percent. Shawn Sullivan, the governor's budget director, said the additional $18 million generated by hiking the hospital fee would be used to replace all state general fund dollars allocated to the initiative. The elevated fee would bring in $65 million annually.
Hospitals who will have an increase in fee costs for receipt of medicaid funds will find that taking services for the poor simply costs more, and will receive less resources to provide. The move in funding directives comes at a bad time for Kansas Mental Health, who yesterday began the painful process of finding spaces for those at Osawatomie State Mental Health Hospital.
In August of 2014, Osawatomie Facility was found by federal medicaid to be out of compliance with it's handling of those with serious mental health issues. The months since have been no better, as I've covered here. The Kansas health institute summed the situation up as follows: http://www.khi.org/news/article/kansas-mental-health-system-under-increasing-stres/
With the patient count so high, many of the hospital’s direct-care staff were pressed into working one, two and sometimes three overtime shifts a week. “The place is over census and understaffed,” said Rebecca Proctor, executive director at the Kansas Organization of State Employees, a labor union that represents many state hospital front-line workers. “Conditions there are really, really bad.” Angela de Rocha, a spokesperson for Kansas Department for Aging and Disability Services, confirmed that the Osawatomie hospital’s patient count on July 15 was “an overall high for the past 10 years.”
With a bed count that authorizes 206 residents, Osawatomie found themselves with a peak of 254 patients in August and staff working triple shifts as there were not enough care providers available and little funds to do otherwise. Due to compliance issues, Osawatomie will need to undergo a construction project, which will reduce the number of patients who can be served to 146 - a reduction that has been ongoing, with Osawatomie down to 167 (or 168, conflicting reports) of patients now, meaning at least 19 are still awaiting placement. It also lowers options for where new patients with mental health issues will go. Other full in patient facilities in the state have been repurposed, leaving outsiders to wonder where the bed count will come from. http://www.khi.org/news/article/governor-announces-plan-repurpose-rainbow-mental-h/
Gov. Sam Brownback today unveiled his administration’s plan for reopening the Rainbow Mental Health Facility. “I think this is a winner,” Brownback said, referring to a Kansas Department for Aging and Disability Services plan for privatizing the state hospital’s operations. The plan calls for converting the former 50-bed inpatient facility to a 10-bed “crisis stabilization resource” designed to connect people with serious and persistent mental illness to community-based services. The new facility also will have a six-bed triage and observation unit and a six-bed detox unit. Only the 10-bed unit will involve patient stays of more than 24 hours.
http://www.khi.org/news/article/governor-announces-plan-repurpose-rainbow-mental-h/#sthash.VmbQdCP9.dpuf With hospitals now seeing an uptick in cost in handling patients of limited means - which often includes the mentally ill, providers worry that the lack of bed space will significantly compound the risk of those with mental health issues finding their way into a jail or out on the street rather than in a care facility. http://cjonline.com/opinion/2015-04-20/editorial-mentally-ill-losing-option
Angela de Rocha, spokeswoman for the Kansas Department of Aging and Disability Services, says community mental health centers have been working with the department to help place patients who can receive treatment in less restrictive settings.
Unstated is the real world pressure to assess patients as meeting that criteria in order to unburden the state and now counties from the unplanned expense of care. http://m.cjonline.com/news/state/2015-04-23/gov-sam-brownback-unveils-72-million-spending-changes-light-400-million#gsc.tab=0
"We will continue to work with the community mental health centers, hospitals, law enforcement and the courts to provide care and treatment for all those who need behavioral health services in the Osawatomie catchment area while this project is in progress," she said. Wolfe Moore said a shortage of community facilities for the mentally ill already existed in Kansas. The Osawatomie shift will exacerbate that problem, she said. "Our fear is they're going to end up in the jails," Wolfe Moore said.
With fewer beds available, and a higher cost to treat those who are amongst the most at risk, no one is quite sure how this will work out. Asking not to be named, a Mental Health Care Case Manager informed me, "I am worried there will be a lot of pressure to just treat & street. And mental healthcare doesn't work that way. This could end very badly." Her fears are remembered in a case last year in Ottawa, and a man in Dodge City. http://www.kake.com/home/headlines/Kansas-teen-killed-in-officer-involved-shooting-272503211.html?llsms=954371&c=y
"He was walking back and they said that they had a complaint and stuff on him out here making a scene," Bruton said. "As I was looking, they kept getting closer. They pulled the guns out. They kept getting closer and closer. You could hear them tell him to, 'Get down, get down,'" said witness Houston Harris. "By the time I got to my son, he maneuvered away from me," said Bruton. "He went up toward the cop, he done something with his hand and about 15 to 16 cops shot rounds off on him, in his chest, his legs, everything." Family members said there have been confusing reports about what happened, including conflicting reports about whether Jennings actually had a gun. Family members said police have made several recent trips to their home. They said the young man had been having suicidal thoughts because of painful seizures and had tried to overdose on Friday.
http://ksn.com/2015/01/07/kansas-jails-struggle-with-mental-healthcare/
DODGE CITY, Kansas– Rickey Schweitzer had been in the Ford County Jail since November 10th, but on New Year’s Day jail staff say they found him dead after an apparent suicide. After allegedly attacking a Dillon’s employee at a Dodge City Dillons, Schweitzer was ordered by a judge to have a competency assessment, but for him and other inmates who need either competency or mental health evaluation, they have to wait for a bed to open up at one of two state hospitals. He was meant to go to Larned State Hospital, but there was no bed available to him.
With Kansas commitment to continued reduction in availability of services for the mentally ill, the question yet to be answered is whether or not we are prepared for the results. Continued reductions in long term mental health care treatment options, and added expense and pressures on local hospitals will complicate issues going forward. All patients who receive medicaid and hospitals may find themselves hurting, but for those who need mental health service, it is another body blow to the hope of treatment.