Connecticut faces budget deficit

Connecticut faces budget deficit
(April 2009 Issue)

By Phyllis Hanlon

Connecticut has yet to feel the full effect of its budget cuts, according to Wayne F. Dailey Ph.D., senior policy advisor in the Department of Mental Health & Addiction Services. However, the state faces a projected $8.6 billion deficit and foresees the need to readjust or eliminate certain programs and services.

Dailey says, "The magnitude of the deficit is tremendous, 24 percent of the state's current budget." To balance the budget, the governor has proposed several small cuts to various programs, including medically managed detoxification, a zero tolerance education initiative and an ambulatory detoxification program.

A more significant impending change is the closure of Cedarcrest Hospital in Newington, which houses psychiatric and substance abuse treatment divisions. Dailey reports that the latter division will relocate to the north end of Hartford without any changes to the program's capacity and will be administratively attached to Connecticut Valley Hospital.

Capacity will increase by one, but the levels of care will change, Dailey adds. Sixty-four beds from psychiatric services will reopen at Connecticut Valley Hospital; 30 will become residential beds under contract with private, non-profit facilities; 30 community beds will be converted to two, 15-bed intensive residential treatment beds run by private non-profits and 10 will reopen at Greater Bridgewater Mental Health Center. "This is all scheduled to be in place July 1, 2010. The hospital will close then. Phase-out is to begin April 1, 2010," Dailey says. "To lose a hospital is a major change."

While reaction to the closure has been mixed, Dailey says that the National Alliance on Mental Illness (NAMI) and other advocacy groups support the proposal. "Basically, we are not losing beds, but some are not hospital level of care," he says.

Medicaid reimbursement plays an important role in the state's fiscal health, according to Mark C. Schaefer, Ph.D., director, medical policy and behavioral health at the Department of Social Services (DSS). He says that the federal government determines its share of medical assistance on a percentage basis. "In Connecticut, for nearly all Medicaid covered services, the percentage is 50 percent," he says. "The percentage is increased under the federal stimulus package for states that don't reduce enrollment." He adds that the governor has proposed cost sharing, elimination of adult dental services and inclusion of psychiatric drugs in the preferred drug list for Medicaid recipients. "This is where the biggest hit will be in terms of the impact on people we serve, not so much on services," says Dailey.

Christine H. Farber, Ph.D., Connecticut Psychological Association (CPA) board member and co-chair of the legislative committee who has a private practice at Aletheia Psychological Services, LLC in South Windsor, calls the economic situation "overwhelming." She points out that there will be no clear answers until the governor's budget passes. "We're in a difficult time," she says. "We're trying to wrap our heads around potential cuts. We can appreciate what the legislature has to do and we are advocating for psychologists and the population we serve."

According to Farber, physical and mental healthcare should be assessed together. "Mental health seems like a luxury in this economy. Basic survival skills have to take center stage," she says. "Mental health will be affected by the whole global health care picture." With 80 percent of the population concerned about losing their jobs, financial issues are causing insidious stress, according to Farber.

She expresses concern for children's and community mental health and for those who seek private services. The CPA is following the legislature's cuts to educational programs, addiction services and to nonprofits that receive state funding and funding in general. She fears the legislature will make changes to a comprehensive anti-bullying law, cut a teen mom program in the Hartford Public School system and increase copays to Medicaid and HUSKY, the state's healthcare program for uninsured kids and youth. "Some of these are not specifically within the realm of mental health, but will affect the mental health of kids, family and the community," says Farber.

Of greater concern is talk of eliminating the office of health care advocate. While the child advocate position will be spared, she would fall under the attorney general, which means she'll have less support. "The concern is that her voice is one of the few for this constituency. Kids can't speak for themselves. The Office of the Child Advocate does that for them," says Farber.

The CPA also raises concern about burnout among practitioners. "We are advocating for our providers to get the funding they need," says Farber. "As private practitioners, we don't see the same things public psychologists see. They are getting less pay for more work. It's a dilemma everyone is facing."

On a more positive note, Dailey points out that some services may see an increase in funding. "There has been a $7.6 million increase proposed for case load growth in youth and adult services for FY10 and an additional $10.6 million in FY11."