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How to Spend $1 billion to Improve North Carolina’s Mental Health System

Credit: iStock

by Lynn Bonner, NC Newsline

The state House has developed a wide-ranging plan to pay for mental health needs with part of the $1.7 billion federal ‘signing bonus’ the state expects to receive for expanding Medicaid.

The House plan that passed the Health Committee last week directs about $1 billion toward mental health costs over three years. 

The list of dozens of proposed expenditures includes money for community behavioral health clinics, a centralized hospital-bed registry, community and residential treatment for children, and a loan repayment program for licensed behavioral health providers who work in rural and underserved areas and take Medicaid. 

“Overall this is a step in the right direction,” said Valerie Arendt, recent past chair of The Coalition, groups advocating for expanded mental health, developmental disability, and substance use disorder services. The mental health system “has been severely underfunded for a long time,” she said. 

The House proposal puts the biggest chunk of money, $225 million over three years, toward raising Medicaid rates for behavioral health providers. Medicaid expansion is expected to give more adults with mental health or substance use disorders a way to pay for treatment. However, providers willing to accept Medicaid’s low payments can be difficult to find. 

Increasing rates for providers would be huge, said Robin Huffman, executive director of the NC Psychiatric Association. Rates have been frozen for more than 10 years, she said. 

The House bill proposes that the next largest chunk, $108 million, would go to community-based pre-arrest diversion and reentry programs. Advocates, county commissioners and sheriffs have talked for years about ways to keep people with mental illnesses out of jails.

The intersection of mental illness and jail is one of NC Department of Health and Human Service Secretary Kody Kinsley’s top priorities, Huffman said. 

North Carolina counties have programs that seek to prevent people with mental illnesses from cycling in and out of jail. 

Alamance County, where Huffman lives, is building a 24-hour crisis center to keep people in  mental health crises from landing in a jail cell or a hospital emergency room. 

She’s heard the effect of a person with a mental illness being arrested over and over described as “serving a life sentence 30 days at a time.”

Other major items in the House bill include:

$38 million for community behavioral health clinics $50 million rural health loan repayment program $60 million for behavioral health urgent care

House and Senate Republicans have said since last winter that they wanted to use $1 billion from the Medicaid signing bonus to improve mental health services. The Senate budget includes some proposals for spending the signing bonus money, but they don’t add up to $1 billion and only a fraction of what Senate Republicans proposed would go to mental health programs. 

Sen. Jim Burgin, a Harnett County Republican and a leader on mental health issues, said last week he had different ideas from the House on how to spend the signing bonus funds, and he’s talked to House members about them. 

Burgin said he’s concerned about spending one-time money on services that could continue indefinitely. 

“I approach it a little bit differently,” Burgin said. “I think we can use some current money to do some things we need to do immediately and then I want to really develop a 10-year plan.”

Burgin anticipated the signing bonus would to go toward facilities and “getting it set up so the providers  can take it and run with it.”

It’s in hospitals’ interest to work to keep people with mental illnesses from landing in emergency rooms with nowhere else to go, he said.

NC Newsline is part of States Newsroom, a network of news bureaus supported by grants and a coalition of donors as a 501c(3) public charity. NC Newsline maintains editorial independence. Contact Editor Rob Schofield for questions: Follow NC Newsline on Facebook and Twitter.