This past legislative session, lawmakers passed a billthat will change who community health care providers can serve. Throughout the summer, stakeholders are now figuring out how to actually implement these policy changes on the ground. Wyoming Public Radio's Kamila Kudelska spoke with Andi Summerville, the executive director of the Wyoming Association of Mental Health and Substance Abuse Centers, on the current process. Summerville said the new system involves priority groups that so far have been separated into three tiers.
Andi Summerville: Tier one includes several categories in it that really focuses on a couple key groups. One of those is criminal justice involvement. So either state level, such as they came out of parole from a [Wyoming Department of Corrections] facility, or non-state level, so they've been sentenced to an offense, probably in circuit or district court. It also focuses on what we call families at high risk. Those are families and children who either are receiving services from DFS (Department of Family Services) in that system, or they could potentially be in that system. The other two in tier one is an acute mental health crisis, that [someone] is experiencing something if we don't get a handle on it, it could potentially end up in the state hospital, or in the reverse people who are being discharged from the state hospital, they're coming back to the community. And then the last category in tier one is adults with what we call severe persistent mental illness. So those individuals will need long-term mental health care and treatment and support. Tier two, that's a little simpler, it's with high needs. And so that tier, you have to be under 150 percent of the poverty level. And we are still working on defining what high needs actually include. And then tier three is simply entitled, indigent. But that's more reflective of the general access system that we have now. But the 150 percent poverty level is a significant shift from the general access system we offer now, which in most cases across the state, allows people to receive services up to 300 percent of the poverty level.
Kamila Kudelska: So let's say I'm in tier three, and I need services, and I go to one of the community centers, how would that work? Because I'm in tier three, would I not be prioritized first?
AS: That is a wonderful question and one that we're working on right now to be honest with you. We have to work through all of these ground level details in terms of how does the state expect us to prioritize people? So if they're in tier three, are they put behind people in tier one and tier two in terms of ease of accessing and health services? And questions like, who decides? Who qualifies in each tier? Those are all questions that we're grappling with right now.
KK: How will this impact the mental health services provided to Wyoming?
AS: There's a focus on really trying to reach people who are in the most need and trying to intervene at that level. The concern that we have as providers is who is going to pick up the people that will no longer qualify for services. They may be receiving service today at a community mental health center and once this system changes in place, where do those people go? How do they access services? We don't have an answer for that, because there's not another pay source sitting out there. So if somebody is, say, at 180 percent, of the poverty level in tiers two and tiers three, and they still can't afford insurance. Again, there's nobody to step in there, per se. Now in tier one, we're still working that out. In the legislation, there is no financial qualifier in tier one. And so again, details that we're continuing to talk about. I think it's important to recognize in this process, through the summer, we'll be working with these stakeholders and the Department of Health on trying to figure out all these details. And then we will report back to the labor health committee in September. But this bill doesn't actually go into effect until July 1, 2022. And so we still have some time to work through all of these details.
KK: Are we worried at all about potentially not providing enough service in mental health service in a state where we already have a high suicide rate and high mental health issues?
AS: That's certainly extraordinarily concerning. This last year, during the pandemic, our community mental health centers have had an increase statewide of crisis calls, both from people that are already clients of theirs and people that are not. The stresses of the pandemic, whether it's related to job loss or loss of contact with the community, is certainly causing quite a few issues across the board. And so that concerns us because we don't know that when we get out of this pandemic, hopefully soon, that will just stop. We are fully anticipating that it's going to take quite a bit of time to deal with the mental health effects of having lived through the pandemic. and so part of these conversations are also what tools can we carry out into the future to ensure that there is access across the state. And I would also highlight one particular piece in the bill that requires the state to establish basically an operating grant targeted towards those smaller, rural community mental health centers to try to make sure that they stay open. Because when you're reducing the number of people that they see, it certainly creates an economy of scale problem.
KK: Anything else you'd want to add that I didn't prompt you on?
AS: The other thing that I would add is that in these conversations, we also need to talk about how we're going to fund community mental health going forward. So we know that some people will be left out of this system change. And even before this, Wyoming is incredibly unique in how it funds its community mental health system, which is primarily a state general fund dollars that are matched to federal block grants from SAMHSA (Substance Abuse and Mental Health Services Administration). Most states don't do that; most states leverage their Medicaid system heavily to support their community mental health. And so we are certainly talking about Medicaid expansion. And what that could do to help fund the system. Mental health waivers through Medicaid, as well as trying to increase grant capacity, both at our local centers, which is sometimes difficult with the small rural centers that don't have a lot of administrative staff and at the state level, so we really need to continue to talk about long-term how we fund a sustainable system moving forward.
