Down To The Bare Bones

Following more layoffs, the Yolo County Mental Health Department is now only taking patients who are severely mentally ill.

From The Daily Democrat by Erin Tracy, February 5, 2010

In Yolo County, compassion has resulted in debt, as the Mental Health Department for years has gone above and beyond state mandate to care for its citizens.

"The General Fund has supplemented our department and for the last five years (our budget) hasn't balanced to the tune of several million dollars," said Director Kim Suderman.

The Department of Alcohol, Drug and Mental Health can now only serve the obligatory severely mentally ill, after 15 employees were laid off and will work their last shift today.

Residents seeking services will continue to be screened at ADMH but those not determined to be seriously mentally ill or disturbed will be referred back to a primary care physician.

"Access continues to be available at the same level but the duration, frequency and intensity change based on medical necessity," Suderman said. "If I'm turning away a psychotic kid because I'm seeing someone with an adjustment disorder, that's a problem."

The Department acts as a specialist in the field of mental health, akin to a cardiologist for physical health, Suderman said.

While ADMH generates revenue, the issue is cash flow.

Only able to serve the uninsured and those with Medi-Cal, the county at best can recoup 83 percent of the cost of services through state and federal matching funds for Early and Periodic Screening, Diagnosis, which includes the under 21 population on Medi-Cal.

Medi-Cal for adults typically pays 61 cents on the dollar and will not pay for services above the state rate. Suderman said the department is still owed state moneys from the 2001-02 fiscal year, and a best case scenario delivers reimbursement after eight months. That's assuming there are no state audits or disallowance due to human error in insurance forms.

The department will help the uninsured apply for Social Security Insurance, but those who don't apply pay what they can through a limited payer source formula developed in 1968. Under this model, the least amount of money a patient will pay is $37 for a years worth of services; an amount inadequate to cover even an hour of service.

For years the department has borrowed against the county's General Fund, which no longer carries the reserves adequate to act as a credit card.

"I still have employees that expect to be paid every two weeks and contractors that expect to be paid every month," Suderman said.

Contractors are one of the biggest points of contention, and the county is currently "brainstorming and planning" with providers to determine what amount of services should be brought in-house rather than contracted out.

Communicare, Yolo Family Service Agency and EMQ Families First provide services to Medi-Cal EPSDT patients.

Communicare providers counsel moderate to high risk juvenile justice youths. The County's Probation Department has invested more than $200,000 in special training for Communicare providers to work with this particular population in a manner proven to reduce recidivism.

Probation Director Marjorie Rist said the two departments and Communicare met Thursday to discuss a means of cooperation between the three revenue streams.

"Times like this require collaborative solutions if we are going to keep any safety net at all," Rist said.

Representatives from the providers have argued that they can provide the service for the same cost, but again it is an issue of cash flow because the county must pay the provider up front before even filing a claim with Medi-Cal, Suderman said.

Regardless of the agency taking on the majority of case loads, more jobs will be lost on either end.

"It's just a matter of who," Suderman said. "We are not trying to rob Peter to pay Paul, we are really trying to work together."

Source: The Daily Democrat

Link: http://www.dailydemocrat.com/news/ci_14340281