LACONIA — A year ago, when the state budget included included $28 million for mental health and a settlement was reached in a lawsuit brought by patients denied proper care, headlines spoke of "a year of change, momentum" for the crippled system, but this week, the New Hampshire Community Behavioral Health Association firmly reminded state officials of promises unfulfilled and problems unsolved.
In a six-page letter, to Gov. Maggie Hassan the association claimed, "While some progress has been made, it is critical that these efforts are continued and expanded — because promised additions to the system have not been carried out, because the provider system is still very vulnerable, because demand is still growing, and because there are significant obstacles that that keep the community health centers from delivering services to those who need them most."
"This is a 'Don't forget about us letter,'" said Maggie Pritchard, executive director of Genesis Behavioral Health in Laconia, which serves some 3,000 mental health patients in the Lakes Region. She said that the letter raised four major issues, all of which weigh on her agency.
Although $28 million was appropriated for behavioral health, $12 million, the association wrote, "was put aside, abandoned or otherwise not made." Some $3.3 million was intended to fund ten "assertive community treatment teams" (ACTS). Pritchard said that Genesis applied to operate a team, investing in a consultant and architect to complete the lengthy application, but "never heard a word." She said that Genesis lacks a secure facility where patients who represent a danger to themselves or others can be held for 24 hours. "The money has disappeared."
Likewise, Pritchard explained that the so-called "spend down," which requires patients earning more than about $600 a month to make payments equal to what they earn over the limit to qualify for Medicaid, costs Genesis approximately $360,000 in uncompensated care. "No one with so little income has the money to pay for care," she said, "so whatever services we give provide them, we don't get paid for."
Nor, Pritchard said, has the state invested in developing and retaining the workforce the community mental health centers require. She said that apart from minor adjustments in compensation to keep pace with other community mental health centers Genesis has not increased salaries for seven years. About one-fifth of the staff of the 160 turns over each year. Prichard said that she currently has 10 vacancies, including eight positions that provide services to patients, but only one resume.
Finally, Pritchard said that with the introduction of managed care companies into the Medicaid system administrative procedures and payment structures have added to overhead. She said that Genesis must manage three different payment and auditing systems, which have tripled the administrative costs of the agency.
Pritchard likened the changes introduced by the state to "putting a third floor on a house without a foundation."
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