HHS decision hurts mental health services, leaders say

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By NANCY HICKS / Lincoln Journal Star

The state’s decision early this year to curb the use of child welfare dollars for adults could make it more difficult for parents to be reunited with children, according to some local human service leaders.      

Some agencies and counselors believe they have lost clients as a result of a memo from the Department of Health and Human Service.

And local human service leaders believe the end result of the memo will hurt the system that provides help to low-income Nebraskans.  

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A memo to caseworkers and others in late February indicated HHS should not use “child welfare” money for adults.  

The “child welfare”money is intended for services to children but was sometimes used to pay for counseling or treatment for parents in a troubled family when  those parents had no insurance, Medicaid coverage or money for treatment.  

That memo was simply a “clarification” of HHS’ long-standing policy, said Todd Landry, director of the Division of Children and Family Services, part of HHS.

The memo was not in response to any particular issue or internal assessment that HHS was spending too much of its “child welfare” budget for adults, he said.  

The state spent about $4.9 million in “child welfare” money, all of it state tax dollars, last fiscal year for services to more than 5,050 people.

And Landry pointed out that the state has increased its “behavior health” funding recently by about $17.1 million. This means there is money for these services to parents, he said.

Some local human services leaders have a different interpretation on both issues.

They believe the February memo was more than clarification.  It meant less  “child welfare” money is being used to pay for  services to parents.

The Independence Center, a BryanLGH substance abuse treatment program, has not seen a client in this category since the February memo.

The memo “was not a blanket no, but a new filter system,” said Jerome Barry, Independence Center director. “However, we have not had any clients since then.”

And local mental health leaders say the recent $17.1 million for local services is not “additional” money but money promised them several years ago as part of mental health reform.   

The state promised that local programs would get the savings that occurred when regional centers were closed or downsized, said C. J. Johnson, administrator of  Region V Behavioral Services, which coordinates services in southeast Nebraska.  

“That $17.1 million wasn’t additional,” and it isn’t “new money,” he said. The bottom line is that the state is spending less money than expected on mental health and addiction programs overall.

But because of that $17.1 million and because these parents have a high priority on waiting lists, most nonprofit agencies are still serving these parents without much delay.

At St. Monica’s, which provides treatment for many women who participate in the Lancaster County drug court, additional state funding has allowed them to continue working with these women.

In addition Lancaster County juvenile court judges have ordered a reluctant HHS to pay for these services when it appears a parent will have to wait on a waiting list.

Local agency directors say HHS just shifted services from one pot — child welfare — to another — behavioral health.

Shifting doesn’t solve the larger problem of an overloaded system, said Topher Hansen, executive director of CenterPointe, a treatment program primarily for adults with mental illness and addiction issues.   

It’s like having too many cats and not enough bowls of milk, he said. There are still more cats than bowls of milk.

An attorney who represents some parents whose children are in foster care points out that HHS is required to pay for children’s treatment by law.  

Often the goal is to reunite children and parents, if the parents’ behavior changes. And the law says HHS has to make reasonable effort to reunite the family, said Pat Carraher, an attorney with Legal Aid of Nebraska.

So if a mother has a meth addiction, it is reasonable to assume that HHS would pay for her treatment with child welfare money, Carraher said.  

Carraher says serious problems have been avoided in this region after the memo because Juvenile Court judges have been requiring HHS to pay for services in some cases.     

“Child welfare has a responsibility (for these services to parents to help with reunification) and they should not be draining scarce resources for other mentally ill adults,” said Dean Settle, executive director of the Lancaster County’s Community Mental Health Center. The center has seen some increase in its waiting list recently, he said.

“I see this as a knotty problem for this state. Now all of a sudden the deck chairs are getting rearranged. It is a net loss to adults with severe mental illness,” Settle said.

Landry says the memo did not represent a change in department practice. It was a response to questions from caseworkers and others, he said.

And he doesn’t think the costs for adult services from the “child welfare” budget has dropped  since the February memo, but he doesn’t know for certain because he does not have monthly data.  

“Our aim in this process is to ensure that we are meeting our statutory responsibilities to make reasonable efforts for reunification of the child when that is the court order on the case, and to do so in a fiscally responsible manner,” he said of the reason for the memo.  

Reach Nancy Hicks at 473-7250 or nhicks@journalstar.com.