Budget cuts could undermine behavioral health progress, especially for at-risk demographics

By: Faith Miller

Originally appeared in the Colorado Springs Independent

Colorado lawmakers and budget staff have a grueling task ahead of them: accounting for a projected $3.3 billion budget shortfall due to the economic downturn occasioned by the COVID-19 pandemic.

Draft budget proposals prepared by Joint Budget Committee staff show that no department will emerge unscathed. One area that’s particularly vulnerable is behavioral health care.

The sector, which encompasses treatment for mental health and substance use disorders, has been a priority for both major parties at the state Capitol in recent years. Mental health advocates fear that some programs passed in 2019, which were set to be implemented in 2020 and beyond, could see delays and funding cuts.

“The kinds of things that they’re going to be trimming out of the budget most easily are things that were passed and had not even been implemented yet,” says Vincent Atchity, president and CEO of nonprofit advocacy group Mental Health Colorado. “…We’ll lose progress [on] expanded access to care for perinatal mental health, maternal mental health, substance use.”

Legislators must approve proposed changes, but April recommendations detailed by staff provide some insight into what’s at risk for behavioral health.

“Asking people to come in and testify on bills at this time is not safe, and not allowing them in is not fair. So it’s a Catch-22.”click to tweet
One recommendation included in the revised budget proposal would be to delay implementation of a grant program passed as part of a 2019 bill that reclassified several existing drug felonies as misdemeanors. The grant program would have appropriated at least $1.8 million from the general fund in 2020 and 2021 to help counties add substance use or mental health treatment services in order to divert people from the criminal justice system.

In the Department of Corrections, the committee approved cutting $1.1 million, or 11 percent of the budget, for behavioral health treatment in jails and prisons.

Another significant cut would eliminate $500,000 for expanding substance use treatment for pregnant women and new mothers, which was designated under a 2019 bill. The bill set aside $500,000 annually for fiscal years 2019-2020, 2020-2021 and 2021-2022.

Staff also recommended cutting $1 million, or half the funding, for a grant program providing mental health training and support to police and sheriff’s departments. The grant funding is required under a 2017 bill.

One of the biggest recommended cuts would come from a 2019 bill that established a grant program under the Department of Human Services (DHS) for substance use treatment in underserved communities, funded by marijuana tax revenue. Due to a projected shortfall, staff recommended cutting $5.5 million from that program.

Also on the chopping block could be $1 million, or 20 percent of funding, designated for school-based community health centers — like Mitchell High School’s new facility — that provide physical and behavioral health care to low-income children.

“A grantee would most likely manage this reduction through reductions in services or personnel, translating into less providers in clinics, reduced days per week the clinic is open, or reduced staff hours per day,” the budget proposal says.

Within the Department of Health Care Policy and Financing (HCPF), which runs the state’s Medicaid program, staff recommended eliminating a $1.4 million program for children and youth at risk of out-of-home placements.

The program, created through 2019 legislation sponsored by Sens. Rhonda Fields, D-Aurora, and Bob Gardner, R-Colorado Springs, would have required HCPF and the Department of Human Services to collaborate on Medicaid-covered wraparound services to assess, screen and refer children for residential treatment.

Because federal money included in the coronavirus relief package is pumping Medicaid dollars back into Colorado’s program, HCPF is facing less painful impacts than some other departments. The out-of-home placement program is perhaps the biggest concern as far as funding tied to recent legislation, says Laurel Karabatsos, the state’s deputy Medicaid director.

Karabatsos says HCPF has requested that the committee not remove funding for that program.

Though the state expects an increase in Medicaid enrollments due to unprecedented levels of layoffs and pay cuts, Karabatsos says she’s confident the department can handle the surge.

“When we expanded Medicaid originally [in 2014], we had a larger caseload than we have now, and then as the economy improved it went down a little bit,” she says. “So I think it’ll be a matter of returning to a similar caseload, and we have been able to handle that in the past.”

Meanwhile, legislators won’t have time, or money, to pass a slate of mental health-related bills already introduced this session when they return on May 26. Those include several bills aimed at opioid abuse prevention and recovery.

An interim committee on substance use had recommended a handful of comprehensive bills that would have increased preventive efforts against addiction, harm reduction services (such as medication-assisted treatment), and drug treatment within the criminal justice system. Many of those bills required large appropriations, and none had been passed by lawmakers before coronavirus shut down the Capitol in mid-March.

State Rep. Lois Landgraf, a Republican from Fountain, isn’t holding out much hope for one of her own big priorities this session: House Bill 2012, a bipartisan effort to expand services for children with intellectual and developmental disabilities or co-occurring disorders (such as a physical condition plus a mental health diagnosis).

Currently, parents must give up custody of their children to gain access to the Department of Human Services’ program for youths who fall into one of these categories and need residential treatment in a facility. HB2012 would allow parents to initiate their children’s placements in the program.

Big picture, the cost of the program is relatively small. Legislative staff originally estimated that it would make around 75 additional children and youths eligible to receive services, and their care would be reimbursed through Medicaid.

The bill, which Landgraf is sponsoring along with Rep. Mary Young, D-Greeley, would require an appropriation of at least $43,000 for fiscal year 2020-2021 and another $44,000 the following year. It had been approved by the House Public Health & Human Services Committee and referred to the House Appropriations Committee in January.

Landgraf, however, thinks that under current circumstances, safety measures at the Capitol could diminish the bill’s chances.

“The decision was made to just run what’s absolutely necessary,” Landgraf says. “…This bill still needs to go to the Senate, it has to be open for testimony, and so asking people to come in and testify on bills at this time is not safe, and not allowing them in is not fair. So it’s a Catch-22.”

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