[T]he elimination of two grants that fund programs to help Vermonters with mental illness and substance abuse stay out of prison would strip those programs’ budgets, limiting their ability to serve the uninsured and underinsured, officials say.
If the cuts go through as proposed, it could reduce services available to people who are not covered by Medicaid.
The Sparrow Project, administered in Windsor County by Health Care and Rehabilitative Services (HCRS), and the Collaborative Solutions Integration Project (CSIP), through Washington County Mental Health (WCMH), could see cuts to funds that are critical to their work.
But with a $94 million deficit to balance in the FY 2016 budget, Gov. Peter Shumlin proposed to eliminate the two grants, amounting to a total savings of $324,411.
The grant reductions will not do away with the projects entirely. Medicaid pays for some of the services Sparrow and CSIP provide.
The governor’s budget proposal includes a 2.5 percent rate increase for Medicaid providers, which, if approved, would increase the amount of money the community agencies receive from Medicaid. The Department of Mental Health (DMH) encourages WCMH and HCRS to make the most of the dollars they receive from Medicaid.
There are some other funding sources available to help the organizations cover the cost of their services, Frank Reed, DMH deputy commissioner, said Monday, citing capacity grants that help pay for people without insurance.
However, he agreed that the elimination of the grants will likely impact the services under Sparrow and CSIP.
“What you hear from providers is understandable,” Reed said. “Any reduction is a reduction that potentially impacts services.”
According to Mark Young of Sparrow, about a third of the project’s clients are not on Medicaid. Without the state grant, he said, “we have to only serve folks who have billable insurance.”
Since its implementation in 2009, 422 people have been referred to Sparrow and 123 have graduated. Program graduates ended up back in the criminal justice system at a rate of 17.9 percent, compared to a recidivism rate of 29.3 percent for participants who did not complete the program, he said.
Margaret Joyal, of WCMH, says that the CSIP grant funds some of the key services that caseworkers offer — reaching out to clients at a Dunkin’ Donuts or in a homeless tent encampment, for instance. Medicaid also will not pay for meetings with a client while they are incarcerated.
When a client fails to show up for an appointment, which, she says, happens frequently with the population CSIP serves, the caseworker’s time is not billable to Medicaid.
“But does that mean that we should not reach out again to that person?” Joyal said. Without the grant to help cover the cost of no-shows, she said, “When someone doesn’t show up, we won’t have the capacity to reach out to them.”
Looking to statewide initiatives
“It is time to integrate this local initiative with the statewide initiatives,” DMH stated about CSIP in a 2016 budget request document.
The Legislature approved a statewide pretrial services plan last year that will make mental health and substance abuse screenings more accessible to people who have been arrested, in hopes that the screenings will help people receive proper treatment and reduce pressures on the state’s correctional facilities.
The services will likely be rolled out later this year.
With federal funding for implementation from the Second Chance Act, the state has said that the pre-trial system will serve a similar purpose to that of Sparrow and CSIP on a statewide level.
“What it will do is help with the coordination of services,” Reed said.
Julie Tessler, executive director of the Vermont Council of Developmental and Mental Health Services, Inc., questions whether pretrial services will adequately pick up the slack where Sparrow and CSIP cut their services.
The relationships that clients have with clinicians at WCMH and HCRS are different than relationships they have with parole or probation officers, Tessler said.
According to Tessler, through site visits and long-term action plans, caseworkers are able to cultivate trust with clients that can be key to preventing recidivism.
“Helping people stabilize their lives is not always Medicaid reimbursable,” Tessler said.
If the Legislature does proceed with the governor’s recommendation, Joyal said that WCMH will look to cover some of the CSIP services through other programs.
“The department has very, very hard decisions to make,” Joyal said. “I empathize with their task, and they’re not capricious in their decisions.”
Monica Hutt, the director of policy and planning for the AHS, said that the agency was faced with difficult decisions when it came to reducing grants.
“For any one organization, that will feel really impactful, but from our end we’re looking to make sure that the real basic safety net program didn’t take the hit,” Hutt said in an interview last month. “It’s not a great choice.”
