Editor’s note: This commentary is by Mary Moulton, who is executive director of Washington County Mental Health Services, and Bill Ashe, the executive director of Upper Valley Services.
[D]uring this legislative session, attention has been given to the need for an increase in the Medicaid rates being paid to the nonprofit designated and specialized service agencies that support many of Vermont’s most vulnerable citizens, because these agencies are at a breaking point. The state relies on them to provide services and supports to nearly 50,000 children and adults, who experience a serious mental health issue, substance abuse, or developmental disability. These are people for whom the state would need to intervene directly if the services and supports provided by these organizations were not available. Most assuredly, if the state supported these persons through state-operated programs, the cost would be much higher.
Underfunding of these programs has been a chronic problem. As agencies statewide struggle to deliver services to all of those in need, they find their organizations are now in a fiscal crisis. The seriousness of these funding issues was recently documented by the Green Mountain Care Board following its independent financial review of the Howard Center in Burlington. The board concluded that “Howard Center’s current budget does not adequately fund the institution’s desire to accomplish its client services missions. … Despite its responsible budgeting practices, as presently funded the agency struggles mightily to recruit and retain the staff it needs so it can meet its programmatic and statutory mission.” This statement is not only true about the Howard Center, but equally reflective of the fiscal status of the entire network of designated and specialized service agencies that the state of Vermont relies upon each and every day.
Currently across Vermont the annual turnover rate in the designated and specialized service agencies averages 27.5 percent.
The designated and specialized service agencies have urgently requested that the Vermont Legislature approve a Medicaid rate increase of 3 percent for each of the next four fiscal years. Attracting and maintaining well-trained staff is paramount to the continued ability for agencies to render quality services. Staff members working for these agencies are extremely dedicated and skilled. They deserve wages similar to workers in other health care settings and state of Vermont employees in order to deal with the economic realities that face their own families. Currently across Vermont the annual turnover rate in the designated and specialized service agencies averages 27.5 percent. In addition, with chronic underfunding other financial pressures multiply, such as providing decent health insurance where annual increases in costs can at times be well over 10 percent or implementing and maintaining an electronic health records system.
Upper Valley Services (UVS) and Washington County Mental Health Services (WCMHS) provide services throughout central Vermont to some of our most vulnerable community members. UVS supports nearly 200 people with developmental disabilities in Orange County and surrounding towns. WCMHS supports approximately 5,000 people with developmental disabilities and mental health needs. Both of the organizations are called upon by the state in unique ways when there are community crises and/or individual crises that warrant our crucial services. For instance, with the recent closure of a single residential care facility in South Barre serving 16 people, WCMHS immediately moved four individuals from the residential care facility, provided nursing to maintain those who were still waiting placement, and sent a crisis clinician to the home to provide psychological support to those who were experiencing this sad and traumatic event of losing their home. Any critical incident causing significant stress can cause a need for these specialized supports.
The state of Vermont must not allow any of the designated and specialized service organizations to fail due to the huge need for these services. As the executive directors of two of these agencies we will continue to do the very best we can with our incredibly dedicated staff. However, we must be clear that our ability to maintain service integrity and fiscal viability of our organizations is being compromised. There must be legislative action now, as well as over the next several years, to assure that the designated and specialized agency system, which the state relies upon so heavily, is placed back on solid financial footing.
