By Matthew Espenshade
President, Pennsylvania State Grange
Pennsylvania is in the midst of a mental health crisis. This health emergency isn’t just occurring in one county or region – it’s happening across the commonwealth and the nation. Exacerbated by the COVID-19 pandemic and an ongoing opioid epidemic, individuals from every type of community and across all industry sectors are suffering. As president of the Pennsylvania State Grange, mental health is an area of concern that often comes up in discussion with my members. Unfortunately, our elected officials and policy makers at the state level continue to turn a blind eye to this growing problem – especially as it relates to Medicaid recipients.
The Grange is the oldest agricultural and rural advocacy organization of its kind in the United States. Rural Pennsylvania is no stranger to mental health problems, we are not immune to these issues. That is why the Pennsylvania State Grange has partnered with organizations like Rural Minds to promote mental health care.
The isolation one can feel in rural areas is difficult and more importantly the lack of access to mental health care is a challenge. Agriculture can – not always – be a somewhat isolating industry. Our members often live in rural regions on large parcels of land. The nearest neighbor or town can be a significant distance. The work is never ending and can be physically demanding. We don’t have weekends off when there are animals and crops to care for. There is no such thing as being closed due to inclement weather. The challenges and pressures are vast and real.
As a society, we have made great strides in removing the stigma that for far too long has been associated with utilizing mental health services. But we still have a long way to go. These efforts are hindered when there is a lack of available services. While the COVID-19 pandemic had devastating effects across the globe, one silver lining was bringing telemedicine even more into the mainstream. But while telemedicine has increased access to services, there is still an underlying issue of having an adequate number of staff and programs to meet the demand and provide quality services. That’s where we need action from the state.
For background, the state (through the Department of Human Services) funds these programs every year as part of its Medicaid budget and through rate negotiations with organizations responsible for managing these services. Unfortunately, this year’s rates did not consider several factors – including a large shift in membership now that the COVID-19 public health emergency has ended; increases in payments to providers for services to maintain access to critical behavioral health services; and a growing demand for behavioral health services. Because the rates don’t take these factors into account, the state has essentially been underfunding these vital services. The rates don’t reflect the reality of the need and utilization of these services, and the state is basically passing their funding responsibility onto primary contractors and counties. It’s an unsustainable situation that is reaching a crisis point.
The Shapiro administration has the power to rectify the situation by performing a mid-year rate review and adjustment — with the majority of the rate adjustment being federal funds. Less than half of the money would come from the Pennsylvania budget as the bulk would come from federal dollars. If the rates aren’t adjusted, the underfunding will continue, federal funds will be left on the table and the problem will get worse. That’s largely because rates for the next year are partly based on the current year’s rates. Each year of underfunding compounds, creating an even bigger funding gap in future years. To put that in real terms — inadequate funding equates to reduced investment in behavioral health systems and programs, increased issues hiring and maintaining behavior health staff — which will negatively impact available services, and additional strains on county budgets and threatening funding for other county services.
Behavioral health services are vital to helping individuals with mental health and/or addiction problems. They are vital to helping our families, neighbors and communities thrive. These are serious issues that left unaddressed can lead to devastating results. The commonwealth has a responsibility to adequately fund these services to ensure access to quality care. It’s time for the state to step up to the plate, acknowledge its financial responsibility and adjust the rates. ••
