Op-Ed: Proposed Rauner Budget Fails to Meet Mental Health, Addiction Health Care Needs

OP-ED: Illinois has a staggering behavioral healthcare challenge and it needs a budget to meet that challenge.

Recent data from the federal Substance Abuse and Mental Health Services Administration underscores the need for a strong, well-funded community-based system of addiction and mental health services in Illinois.

Between 2010 and 2014, the behavioral healthcare challenges, such as depression, suicide risk, drug and/or alcohol abuse, for Illinois men, women, and children have mounted.

  • About 105,000 adolescents’ ages 12-17 report having at least one major depressive episode, while only 38% received treatment for their depression.
  • 355,000 adults 18 and over report ‘serious thoughts of suicide’; while ~363,000 qualified for a Serious Mental Illness (SMI) diagnosis.
  • Of the 1.53 million Illinois adults having ‘any mental illness’ (AMI) in the previous year, more than 55% did not receive mental health treatment.
  • Similarly, only 11.7% of the estimated 267,000 individuals 12 and older dependent on or abusing illicit drugs received treatment for their substance use disorder.

While behavioral problems and needs are clear, funding for addiction and mental illness prevention and treatment has been continually reduced by the Illinois General Assembly. In the past five years, the legislature has slashed state funding for addiction prevention, cut addiction treatment by 40% and mental health treatment by nearly 25%.

Meanwhile, an epidemic of heroin and non-medical use of prescription drugs has exploded across the state, forcing Illinois’ jails and correctional centers to become ill-equipped triage centers for individuals with mental illnesses and/or substance use disorders. Cook County Sheriff Tom Dart has repeatedly stated that the Cook County Jail is now the ‘largest mental health institution in the country’, and a majority of the individuals under his care are also there as a result of untreated addiction.

Over the past several years, Illinois has witnessed an expansion of mental health and addiction parity, the implementation of the Affordable Care Act, and a shift from state General Revenue Funds and Medicaid funding to a system of Managed Care funding, all of which has been implemented by providers in the trenches. At the same time, providers have borne uncompensated, additional expenses associated with implementation of Electronic Health Records and electronic billing. These changes have occurred while the legislature has almost annually imposed funding reductions on community providers, refused to raise historically low reimbursement rates, and left unresolved a Fiscal Year 2016 budget impasse that threatens to undermine our system of community-based care at its core.

While the staggering challenges to Illinois behavioral healthcare community providers continue to bear down, the policy prescription in the form of Governor Bruce Rauner’s proposed FY 2017 falls, let us say, short. In fact, the Governor’s budget proposal continues to move Illinois in the wrong direction, threatening to decimate the already-weakened safety net for Illinois’ most vulnerable citizens.

At a time when the need to prioritize state dollars for the maximum return on investment, reductions to the community behavioral health system are short-sighted and ill-conceived.

Data from national studies have concluded that addiction and mental health treatment not only produces measurable, positive outcomes, but also yields substantial savings to states. A 2014 actuarial study by Milliman found that $26-$48 billion could be saved nationally through effective integration of medical and behavioral services.

Additionally, several studies underscore the positive impact of addiction and mental health services:

  • A 2004 randomized trial studying employer costs found that ‘consistently-employed patients in an enhanced depression management program had 8.2% greater productivity and 28.4% less absenteeism over two years than employees receiving ‘usual care’.
  • The reduction in absenteeism and increase in productivity had an estimated annual value of $2,601 per full-time equivalent employee.
  • The state of Washington compared disabled Medicaid enrollees receiving SU treatment with the untreated population, finding that average monthly medical costs were $414 higher for those not receiving treatment, and with the cost of the treatment added in, there was a net cost offset of $252 per month or $3,024 per year. For individuals with opiate-addiction, cost offsets rose to $899 per month for those who remain in methadone treatment for at least one year.
  • The same study also found that prior to their SUD treatment expansion initiative, healthcare costs for Medicaid disabled clients with SUD problems were rising at a rate of 11% per year. Under the SUD treatment expansion initiative, the growth in healthcare costs was slowed to just 2.8% per year.

The solution is clear.

The Illinois General Assembly and the Governor must prioritize funding for addiction and mental illness prevention, treatment, and recovery support. Lawmakers and the Governor need to end the funding reduction cycle. Now. Instead, Lawmakers and the Governor need to close the gap between those needing behavioral healthcare and those receiving it. Lawmakers and the Governor need to invest in behavioral healthcare.

The governor’s proposed FY 2017 budget fails to do that.

The budget needs a do over.

Sara Moscato Howe, CEO, Illinois Alcoholism and Drug Dependence Association


OP-ED: “Unbalanced Budget Response Act” Would Undermine Illinois Behavioral Healthcare


Eric Foster, Vice President for Substance for Policy, Illinois Alcoholism and Drug Dependence Association

OP-ED: Illinois behavioral healthcare providers are faced with many daunting, financial problems uncertainties as they struggle to deliver quality mental health and addiction treatment services to fathers, mothers, and children in need.

The “Unbalanced Budget Response Act” would make their job worse.

First, since Fiscal Year 2009 through Fiscal Year 2015, Illinois eliminated state funding for addiction prevention, cut addiction treatment by 40% and mental health treatment by nearly 25%. In Fiscal Year 2016, Governor Bruce Rauner cut behavioral health providers by another 25%.

Second, over the past several years, behavioral healthcare providers have had to shoulder the vast implementation expansion requirements for the Parity of Mental Health and Substance Abuse Act, the implementation of the ACA, and the shift from state GRF/Medicaid to Medicaid Managed Care. Moreover, non-profit providers have had to absorb the additional expense associated with implementation of Electronic Health Records and electronic billing.

These herculean bureaucratic demands had to be implemented while simultaneously being hit by the legislature and governor with budget reductions in overall funding for services and no meaningful increase in reimbursement rates to actually cover the growing costs of doing business, such as implementing new mandates.

A recent report from the Illinois Partners for Human Services has found that stagnant reimbursement rates have had significant negative impact on the provider’s ability to cover basic operation costs. Low rates contribute to high employee turnover. Low rates blunt the expansion services to meet the growing needs of Illinois citizens. Low rates leave Illinois exposed to each new drug crisis.

The report also shows that in order to be current with cost of living, reimbursement rates for substance abuse treatment would need to increase by 27% and rates for community mental health services would need to increase by 16%.

Meanwhile, the “Unbalanced Budget Response Act”, Senate Bill 2789, would grant the governor the power to reduce rates unilaterally and without appeal. That authority to gut the last remaining financial life-line that has helped to keep Illinois’ limping behavioral healthcare system function would be an abrogation of the legislature’s own authority and of its own responsibility to the constituents to whom they serve.

Behavioral healthcare providers will be unable to sustain a service if they cannot cover the costs of rendering that service. Granting authority to arbitrarily reduce provider reimbursement rates would be a fatal blow to an already crumbling mental health and substance abuse treatment system.

The Illinois Alcoholism and Drug Dependence Association vigorously opposes this legislation.

Eric Foster, Vice President for Substance Abuse Policy, Illinois Alcoholism and Drug Dependence Association