By Kara Johnson-Hufford, CBHC CEO
There is no doubt that Colorado invests significant state dollars in community mental health centers and clinics across Colorado with about $500 million flowing to the 17 centers that blanket the state. It’s important to understand what Colorado’s return on that investment is in lives saved, quality of life improved and communities supported.
Funding for behavioral health, particularly for the most persistently mentally ill and the infrastructure needed to serve that population, has always been a source of continual debate. After more substantial federal support evaporated in the 1980s, states were left struggling for how they would meet the significant costs of providing these services. At that time access to Medicaid dollars saved the centers by adding new dollars to fund basic needs like facility upkeep and expansion and staffing costs. Medicaid funding allowed the centers to expand their population served beyond individuals with significant mental illnesses to anyone Medicaid eligible with a mental illness. Meaning more people had access to the kind of care that could ultimately improve their quality of life.
Over time, new services and supports were added either by state leaders in search of solutions or in direct response to community need. While state and federal block grant dollars are often inadequate to fill the continuum gaps, local dollars in the form of sales tax initiatives have directed additional funding to some communities. The Denver sales tax and the recent voter-approved tax in Larimer County are two examples. In recent years, state support for substance use disorders has increased, as has the importance of focusing on whole-person care. As a result, more centers have evolved to offer services for people with substance use needs in addition to mental health challenges. The national opioid epidemic has freed additional funding for some new programs as well.
The launch of the Medicaid capitation program in the late 1990s created additional resources, as did the passage of the Affordable Care Act which expanded Medicaid eligibility to cover new categories of individuals in need of services. Prior to Medicaid expansion, centers would spend the small amount of general fund resources for people who were both unable to pay for care and seriously mentally ill as well as seriously emotionally disturbed Coloradans long before the end of the fiscal year. Now, those general fund dollars help build necessary capacity in the community to allow the full spectrum of services to be available to more people in more areas of the state. It is much more difficult, for example, to support 24/7 inpatient programs in rural and frontier areas of the state that could not sustain these types of facilities simply due to smaller populations, but still need treatment options in community.
Over the last two decades, funding has also expanded to support efforts to treat individuals involved in the criminal justice system. This has included everything from additional training for local law enforcement on how to best manage an issue where someone presents with a serious mental illness, to providing additional services to those individuals transitioning out of jail and prison who also need mental health and substance use disorder treatment.
So today, Colorado continues to evolve and grow its funding support streams as populations need additional care and new community-identified needs arise. And the return on investment is clear in many ways:
- The amount of money Colorado invests in support for mental health and substance abuse treatment, when divided out over the more than 200,000 people cared for annually means about $2,000 per person. That small amount supports staffing and physical infrastructure that operates all day long, all year long.
- When people receive needed care in the community at approximately $2,000 a year, that pales in comparison to the annual cost of incarceration or care at a hospital.
- When people are treated in their home community, they can continue to work and engage with their families, thus creating long-term savings to the family and community.
- Early intervention and prevention services help children and families stay engaged in work and school and provide the necessary supports to help link people to higher levels of care when needed.