Mental health care continues to be "greatly underfunded" in the territory, Human Services Commissioner Chris Finch said during Senate budget hearings Wednesday, urging the Senate to give a different agency – the Health Department – more funding.
Mental Health as a program area is under the prime responsibility of the Department of Health but the needs of persons with mental illness affect all public systems. Human Services spends and manages over $12.3 million dollars a year on mental health and substance abuse services, mostly for residential care for youth with mental health needs.
But Finch noted funding and services are shrinking. "The inpatient psychiatric unit at (Gov.) Juan F. Luis Hospital has been closed for two years," he said. "Each new residential placement requires a struggle to find funding. Successful Clubhouse programs on both islands have closed. The territory has insufficient numbers of mental health workers and case managers. Service providers, health care providers, family members and advocates are frustrated,” he said.
“Foster care and Juvenile Justice staff report a high number of clients with mental health issues they are not trained to address,” Finch said. “There is a growing problem of serving senior citizens with mental health issues that we are unprepared to meet."
Finch said he understood that the Department of Health would be submitting a supplemental budget request for mental health services. " I urge you to consider it seriously," he said.
On a brighter note, Human Services is working to expand Medicaid in the territory to get maximum advantage of federal Medicaid expansion funding through the Affordable Care Act, which Finch said will mean fewer uninsured, nonpaying patients in the territory’s hospitals, helping both patients and the hospitals.
The first expansion last August raised the income eligibility limits for children and pregnant women by $1,000, which Finch said extended eligibility to around 3,000 children and more than 200 pregnant women.
The second phase, which began in January 2014, involves enrolling about 4,000 people into Medicaid who "appear to also be eligible for Medicaid but have not yet enrolled," Finch said. These are people who are receiving Food Stamps whose income information indicates they are eligible, he said. This would enroll more children and pregnant women, as well as parents of the children added, senior citizens, disabled citizens and former foster children ages 18 to 26.
Human Services is working with the Centers for Medicare and Medicaid Services on approval of an outreach and enrollment system "with minimal administrative burden," which CMS has said it will approve very soon, Finch said.
The third expansion will increase the income eligibility limits for all covered groups. The fourth will add childless adults as a new covered group, he said.
"We expect to have all of this implemented later this year. The third and fourth expansions will greatly increase the number of formerly uninsured people now covered under Medicaid," Finch said.
The Human Services budget requested $79.8 million in Fiscal Year 2015 local funds, with $62.3 million from the General Fund, paying for regular operations of the department’s 10 divisions. Another $5.5 million is from the Miscellaneous section of the budget, with $3 million of that for Medicaid matching funds; $1.5 million for the Energy Crisis Assistance Program and half a million to pay for four nursing home beds at Sea View Nursing Home. Another $1.8 million is expected from the V.I. Lottery for the Pharmaceutical Assistance Fund and $1 million from the Crisis Intervention Fund.
Human Services expects $68.7 million in federal funds and it expects to distribute "at least" $55 million for Supplementary Nutritional Assistance Program Food Stamps. Taken all together, Human Services will manage about $196.6 million in FY15, with 37 percent from local funds and 63 percent federal, according to Finch.
Also Monday, V.I. Chief Labor Negotiator Valdemar Hill testified in support of the Office of Collective Bargaining’s budget request of $6921,000. Hill said the entire budget is to come from the Union Arbitration Award and Government Employee Increment Fund.
Personnel wages and salaries account for $436,000 of that, and Social Security, Medicare and benefits another $134,000. The office also budgets $73,000 for "other services," such as communications, custodial services and various professional services. Utilities comprise $17,000 or 2.4 percent of the budget.