| Bob Greenburg |
Cuts in Medicaid payments and lower funding from the state may result in some who were eligible to use Four Corners Mental Health’s services not receiving treatment at low or no cost in the future.
“Let’s put it this way,” Bob Greenburg, director of the nonprofit corporation mentioned to the Carbon County Commission on April 21, “The way they are distributing Medicaid money now, compared to the past, will take away resources that we have been using to help the working poor.”
According to Greenburg all kinds of care for those on the edge of insurance or with little money to spend will be affected, even major hospitalization.
“Not many years ago the state had many psychiatric beds to offer us if we needed them at very low cost,” he said. “As of July 1 we will only have two available and that cost will be around $600 dollars a day or about $200,000 a year. And those beds are already full.”
The statement is a reflection of only a few of the changes that will be taking place at the organization which was formed in 1972, originally as an arm of county government. Later, in 1989, it became non-profit entity with a free standing board of directors, and the sole contractor to Carbon County for mental health/ substance abuse services.
“What has happened is a hard thing to explain and make clear,” Greenburg remarked. “A number of years ago we operated by taking direct payments for Medicaid services we provided, with the federal government paying the direct costs for each individual. Then someone at the Federal level began to think that all mental and substance abuse costs were too high and started to explore alternatives to that funding.”
At the time what Medicaid decided to offer was a plan that would turn agencies like Four Corners into a kind of mental health HMO. They offered to pay such agencies a flat monthly fee for every Medicaid card holder in its operating area, rather than paying exact costs of treatment for individual patients while other card holders didn’t use the services at all. What it came down to was a kind of insurance premium, where money comes for everyone to serve those that need it.
“We and two other mental health agencies in the state decided it would be a good idea to go with that, because any money left over could be used to invest in treatment facilities and for patients who didn’t qualify for Medicaid,” Greenburg stated. “And for many years it worked fine. We found ways to reduce costs, which put us in a reasonable financial condition. We could then use the money we received above treatment costs for those who couldn’t pay, but didn’t qualify for Medicaid.”
But a change came two years ago when the federal government altered the rules on Medicaid. As of last August they are once again only paying for direct services for Medicaid patients. Any savings that were made during the flat rate period now belong to Medicaid.
“What this means is that many of the people who have no insurance or little money will not be able to get government supported services from us anymore,” lamented Greenburg.
Of course, Medicaid is not the only funding source for Four Corners. They are the sole contractor for mental health and substance abuse for three counties in the area, Carbon, Emery and Grand. Through that route the organizations receives about $200,000 directly from the counties, with Carbon, which has half the population of the three, contributing near $100,000 per year. In addition the state supplies funds, which are also administered by the county because they have been designated as the authority for those monies by the state.
“The problem is that state money is distributed mainly based on population, but there is only the same amount of dollars as before. We aren’t growing in numbers like some other areas so our funds are actually declining as they are spread farther and farther over a larger population in other parts of the state,” explained Greenburg. “Basically we are losing $160,000 a year now that we had in state funds before.”
Not all the money that the state or the county contributes is available to Four Corners to use, either. Because of federal law, for every dollar the entity receives from Medicaid, it must send back 25 cents.
Greenburg said Four Corners has already cut many of their budgets and have put off building a facility they were planning in Moab. Presently the corporation employs 114 people in the three counties with 64 positions presently in Carbon County.
“We are now in the process of cutting back about five and a half positions and that’s just the start. For the last 10 to 12 years we have been able to protect people on the edge from bad decisions that have been made concerning budgets for mental health in Salt Lake and Washington D.C. But, we can’t do that anymore. Those poor judgments in the funding process are now coming home to roost on the backs of the people the system should be helping,” he concluded.