LINCOLN, Neb. (Nebraska Examiner) — At Behavioral Health Solutions, an increase in demand for mental health care because of COVID-19 has grown into a waiting list of more than 100 people for one of the 58 inpatient treatment beds at the nonprofit’s sites in Norfolk and Columbus.
Meanwhile, the organization is competing for employees with local fast-food restaurants, which pay just as well as its starting wages of $14-$15 an hour.
So when Jay Fleecs learned Monday that Gov. Pete Ricketts had vetoed a needed increase in provider rates for his organization, it was a punch in the gut.
Expansion plans on hold
Plans to expand the facility to deal with the waiting list went on hold, as did talks of raising salaries. Fleece said it’s hard to blame employees who take a job elsewhere or move on, but he said an increase in provider rates is needed to fill vacancies at his agency and fill the need for services.
“Do you go to Burger King for the same price, or do you go to a treatment center for people in crisis?” he said.
Fleecs, as well as the head of a coalition of behavioral health providers, argued Tuesday that such providers of mental health services sorely need the 15% increase in provider rates that state lawmakers had included in its recently passed budget.
He said that state reimbursements for services for Medicaid patients has never matched the actual costs but that Behavioral Health Solutions was able to scrape by because of higher rates paid by private paying customers.
Rate hike left at 5%
The governor’s veto leaves providers of behavioral health services with a 5% rate hike this year, which advocates say translates into continued struggles to hire workers and fully staff services, as well as continued waiting lists.
Fleecs said if his agency could get fully funded, it would move ahead with adding 44 new inpatient beds. In the long run, that would help stabilize people with mental health struggles and help them get off Medicaid and become productive citizens. He said it could also prevent some people from committing crimes that fill state prisons.
“This 15% increase would be a win-win for everybody,” Fleecs said. “I don’t know if Gov. Ricketts understands that.”
The governor, in his veto message to state senators, said the $52 million he vetoed should be devoted to tax cuts rather than 15% provider rate hikes to those who care for the mentally ill, developmentally disabled, children who are state wards and elderly in nursing homes. Provider rates for behavioral health, Ricketts added, were raised 2% a year ago, making it a total increase of 7% even with his vetoes.
“It’s important that we strike the appropriate balance between calibrating government spending and returning excess revenue back to the people,” wrote Ricketts. The vetoes, which included cuts in funding for several other items, would allow tax relief to “succeed,” he added.
Those words brought an angry response Tuesday on the floor of the Legislature by State Sen. John Stinner of Gering, who heads the budget-writing Appropriations Committee.
Stinner said he had worked with the governor in determining that the state could afford a tax-cut package that will grow to $900 million after five years. He added that the provider rate hikes approved by the Appropriations Committee and Legislature also fit within state budget projections.
The vetoes, Stinner said, made Tuesday his “worst” day in eight years as a state senator.
“This is disgraceful,” the senator said. “There’s no way I’m going to give tax breaks on the backs of providers.”
The comments by Stinner, who has made increasing provider rates a priority this year, set off discussions of pairing the tax cut bill with the veto overrides — if the tax cut bill succeeds, then so should the veto overrides.
Whether that deal carries the day may be known soon. On Tuesday, the tax cut bill advanced after overcoming a filibuster and faces one more round of debate. The veto override vote could come as early as Wednesday.
Veto override vote coming
Lincoln Sen. Anna Wishart, the vice chair of the Appropriations Committee, expressed confidence that the veto overrides would succeed.
She said the committee’s goal in increasing provider rates was, in part, to allow providers to provide better wages, in the $18 an hour range.
Providers are having a hard time hiring help, Wishart said, in part because the governor has raised wages for state prison workers and others to compete with wage inflation in the private sector.
Former State Sen. Annette Dubas, who is now executive director of Nebraska Association of Behavioral Health Organizations, said the majority of her 52 members are nonprofit groups that rely heavily on public dollars through provider rates. But those rates haven’t met actual costs for years and years, Dubas said.
Less staff, less access
Now, she said, increased demand for services and shortages of staff mean that not all services can be provided, thus providing less access to help.
“COVID-19 really raised the demand, especially for residential services, Dubas said.
At Behavioral Health Solutions, Fleecs said the agency was planning to move ahead with converting a former nursing home in Norfolk, adding 44 more residential beds.
But now that’s on hold, pending a vote on the veto overrides.
Fleecs said he’s hoping the governor considers the “long-term” impact of improved behavioral health services instead of the short-term veto of funding.
“Think about helping people get off of Medicaid. Think of people becoming part of a civil society again,” he said.
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