Counties fight plan to nix Medicaid behavioral health model

  • Brett Sholtis/Transforming Health

Legislation to combine Medicaid’s physical and mental health services in Pennsylvania is getting pushback from the county agencies that administer those services.

The plan would eliminate the state’s $4 billion behavioral health program, called Behavioral HealthChoices, merging it with the state’s $12 billion physical health Medicaid program.

Republican Senator Kristin Phillips-Hill of York co-sponsored the senate version of the bill. She said the current model, known in the health care industry as a “carve-out” model, isn’t working.

“Just look at York County,” Phillips-Hill said. “In the last 10 years we’ve had a 34 percent increase in the rate of suicide. If the behavioral health carve-out was working, we would not see these massive increases in behavioral health challenges.”

Combining programs for mental and physical health would help patients and save taxpayers money, Phillips-Hill said. However, It would do away with a program that allows counties to apply for funds for behavioral health projects.

“It would assure that the dollars counties get would go directly to care for that patient, not to do other things,” she said. “And look, the counties have concerns because they get excess dollars that they can use to do different things.”

In southwestern Pennsylvania, those funds recently provided 15 extended acute care beds for people with illnesses like schizophrenia and bipolar disorder, said Westmoreland County Mental Health administrator Dirk Matson.

“And that’s something that’s really unique to our area right now that we’ve needed for a long time with so many consumers leaving the state hospitals and needing to have a transition step back into the community,” Matson said.

Those funds have also allowed the county to set up an “Assertive Community Treatment” team, which is a less-restrictive way to help people who live with serious mental illnesses, he said.

Matson fears that combining the two Medicaid systems will take money that would go to county mental health programs and give it instead to managed care organizations like UPMC and Aetna.

In Dauphin County, mental health administrator Dan Eisenhauer opposes Phillips-Hill’s plan, saying it would limit counties’ ability to meet community needs.

“My bigger concern is our ability to leverage and manage the plan locally,” Eisenhauer said.

He noted, counties can only apply for mental health reinvestment funds if they’ve already managed to spend less than the state allocated to them. That hasn’t happened in recent years in Dauphin County, which struggles to provide needed services after statewide budget cuts in 2012 slashed mental health funding by 10 percent.

The County Commissioners’ Association of Pennsylvania also opposes the legislation for similar reasons.

Democratic Gov. Tom Wolf’s administration is still reviewing the bills, said spokesman J.J. Abbott.

“The administration remains committed to better coordination of and access to physical and behavioral health services within the Medical Assistance program, and we believe a public conversation is important on how to better achieve those goals,” Abbott said in an email. “These bills present one option, but we are interested in other potential solutions and continue to engage with interested parties on a path forward.”

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