The writer is executive director of the Nebraska Association of Behavioral Health Organizations.
As the Legislature looks to finalize our state’s budget, determining priorities that support our economy and include the physical and mental health, safety and welfare of all Nebraskans is critical. Our world has changed, but identifying our key priorities remains vital.
The Legislature may be faced with potential budget cuts not envisioned prior to COVID. Which line items will be deemed necessary and critical for our state to function, and which will be defined as “discretionary”? Keeping mental health and substance use treatment services funded and stable in these very unstable times must be considered essential.
One in five Nebraskans will need behavioral health care at some point in their life. Those services range from short-term care for acute anxiety or depression, to intensive care for addictions, to ongoing care for the most serious and persistent mental illnesses. Individuals often have co-occurring physical ailments such as heart disease, high blood pressure or diabetes that are exacerbated by mental illness or addiction. Left untreated or under-treated, these conditions result in diminished quality of life, fractured families, involvement with child welfare systems, poor job and school performance, increased involvement with law enforcement and corrections, and much higher medical costs.
The demand for behavioral health services is growing, and the effects of COVID-19 are only adding to that growth. Social distancing and isolation are effective to protect our physical health but extremely detrimental to those dealing with mental illness and/or addictions. One key early indicator is the increased use of hotlines — mental health, suicide prevention, rural crisis, child welfare — all are critical lifelines for Nebraskans in crisis. With thousands of Nebraskans trying to cope, it is even more important that we do not make cuts to the system attempting to serve a basic need — behavioral health care.
Behavioral health providers rely heavily on public payer compensation for their services. For many providers, upwards of 70% of their revenues come from Medicaid and Nebraska’s regional behavioral health authorities. Due to the pandemic, many more Nebraskans who lost their jobs will rely on this funding to access health care. Medicaid expansion will allow more individuals to receive care, making it imperative that the system is financially viable. The rates paid by Medicaid and the Division of Behavioral Health are on average 18% below the cost of providing care. Making cuts within any of these systems will severely decrease access to care and hinder our communities as we move forward and begin to recover — financially and emotionally.
Health care, and especially behavioral health care, must not be viewed as “discretionary.” Recent decisions by the Legislature have supported the need to build sustainable capacity in the behavioral health system, and their continued vigilance in this area is essential in the days ahead.
The current budget that the Legislature will be charged with finalizing contains desperately needed funding for targeted rate increases in the behavioral health system, including for halfway houses that primarily work successfully with those coming out of the corrections system. “There is no health without behavioral health” rings truer today than ever before. To fully recover from the effects of this pandemic will require a health care system that is fiscally sound and readily accessible to those in need.
Behavioral health care funding must be a priority.