“I would not want my neighbor who was mentally ill not to have the medication that he couldn’t afford,” Commissioner Marc Kraft said during a February 4 presentation by consultants Health Management Associates of Michigan on the operation and finances of the Douglas County Health Center. 

“I don’t know if he was eligible for Medicaid. But, he went to CMHC on a regular basis,” said Kraft praising the services provided to mentally ill citizens by the Community Mental Health Center. “It kept him calm and prevented him from standing in the street naked threatening to kill dogs. The money we spend is an investment in keeping people out of the jail.”

The $311,000 HMA study was commissioned at the request of a blue ribbon panel of local volunteers who decided that a professional analysis of the DCHC was needed. The report can be read online on the Douglas County website. 

Mary Ann Borgeson dispelled rumors that DCHC was going to be shut down because it is “losing a million dollars a month.” She added, “We have received many e-mails slapping us on the wrist for shutting the facility down. We have not made any decision to do that. I know this is a very difficult, touchy, unnerving conversation. We are here to look at the details of this report and see where we go from here.”

Numerous people who spoke at the presentation echoed Kraft’s sentiment that the money spent on DCHC was an investment in the community — not a loss.

The cost of putting a mentally ill person in the Douglas County Department of Corrections is approximately ten times the cost of treating him or her as an outpatient at the Douglas County Health Center. 

According to Dr. Mark Foxall, Director of the Douglas County Department of Corrections, “The average cost of incarceration at DCDC is $90 per day, $2700 per month and $32,000 per year. This cost does not include specialized mental health treatment or medical costs.”

“The cost for an inpatient day at CMHC is about $1100,” reported John Sheehan, Director of CMHC, “The cost for an outpatient visit is about $250 including medications. Thus, a patient seen once per month costs about $3000 a year. The goal is for individuals to receive outpatient care that prevents hospitalizations and incarcerations.” 

“In 2012, the average daily population at Douglas County Department of Corrections was 1107 inmates. In 2012 an average of 20.67 percent of that population received some type of psychotropic medications,” wrote Foxall in an e-mail. 

When an individual with mental health issues is arrested they are placed into a correctional environment. Goals in the correctional setting differ from those of a mental health facility. Our priority is in the stabilization the mental ill individual,” Foxall explained. “There are limited opportunities for mental health treatment in this setting. If the individual is violent they may be placed in segregation for their own safety as well as the safety of other inmates and staff. Mentally ill individuals who are incarcerated are not treated as patients due to the physical plant and mission of the facility. Limited movement, isolation and lack of treatment opportunities in a correctional environment may cause further decompensation of a person with mental illness or cause exacerbation of the mental illness. DCDC is not designed for treatment of the mentally ill.”

In addition to an operational and financial analysis, HMA’s report examined a key area for future funding, stating, “By all accounts, it appears that the State of Nebraska will elect not to implement the voluntary (Medicaid) expansion, although the Affordable Care Act provides 100 percent federal funding for the initial three years of coverage and no less than 90 percent thereafter. The implication for Douglas County is that the majority of users of outpatient services will remain uninsured, thus representing a lost opportunity for an infusion of funding. Douglas County should advocate for the Governor to reconsider the current position of rejecting the Medicaid expansion.”

The Commissioners passed a resolution supporting passage of two bills in the Unicameral, LB 577 and 578, implementing Medicaid expansion. The resolution stated these bills “would save Douglas County millions of dollars in medical costs annually for persons who otherwise would be eligible for County services at the taxpayer’s expense.” Douglas County estimates the savings would be $4.7 million dollars per year. 

Commissioner Clare Duda met with Governor Heineman to discuss the issue. He expressed doubt that the Governor would change his mind. “If we get Medicaid, it will be because of the legislature,” he said.

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