Connecticut governor proposes partially privatizing mental health, addiction services

Connecticut Gov. Ned Lamont has proposed a budget (PDF) for 2020 that would convert some of the state-operated programs to private operations, including some services that are currently offered via satellite Local Mental Health Authority locations, residential and inpatient beds.

This restructuring will not result in a reduction of available beds within the Department of Mental Health and Addiction Services (DMHAS) system, says a spokesperson for the DMHAS. The goal is to strengthen the department’s community partnerships. Plus, Lamont's office projects that the budget will help reduce costs in the state by $2.3 million and up to $4.3 million in fiscal 2021.

“It is the Department’s intent to not only maintain the existing number of beds but also to ensure such services are maintained within the communities they are currently being provided,” the spokesperson told FierceHealthcare. “Therefore, a service reduction is not anticipated from this transition. Instead, the goal is to better integrate services within the community provider network.”

By reducing the overall state budget, the governor will be able to reduce grants from Substance Abuse and Mental Health Services Administration (SAMHSA) for subsidies for uninsured individuals by more than $2 million in both 2020 and 2021.

DMHAS Commissioner Miriam Delphin-Rittmon gave testimony before the state’s Appropriations Committee on March 1. Delphin-Rittmon’s statement included some specific changes including privatizing 41 young adult residential beds currently operated in the cities of Hartford, Torrington, Portland and Bridgeport. The DMHAS would also like to privatize 16 mental health inpatient beds at Capital Region Mental Health Center in Hartford by purchasing 16 beds in the Greater Hartford community. In addition, the budget would take state-operated transitional residential services to private operations.

“This budget aligns with the DMHAS mission and vision by continuing to focus funding on community services to advance our recovery-oriented system of care. The proposed budget realizes efficiencies by leveraging non-profit expertise by transferring certain DMHAS state-operated LMHA services to community non-profit provider operations without any loss of service capacity or compromising the quality of services,” she said.

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The DMHAS service system is already a collaborative partnership between publicly and privately operated services. The proposed budget further invests in community partnerships by converting some state-operated services to private operation while maintaining the existing service capacity throughout the entire DMHAS system of care.

“This initiative challenges the department’s leadership to invest in high quality and efficient community solutions while ensuring the continuation of meaningful relationships with caregivers,” the spokesperson said.

The transfer is part of a no-layoff option and will allow state employees to remain working while maintaining services for clients and reducing costs to the state. The DMHAS believes that the agency already has a high employee turnover rate, so this reduction can be conducted without layoffs.

When asked about alternative potential cost-saving options, the DMHAS spokesperson warned that other options could lead to a reduction in the level and availability of services provided to citizens.

In addition, the governor recently made clear his commitment to combating the opioid crisis through his budget and legislative initiatives.

First, H.B. 7159, which was approved by the General Law Committee, reduces the likelihood of misuse of prescription opioids by strengthening the oversight of prescriptions for opioids, facilitating the use of investigatory tools, prohibiting discrimination to individuals who use life-saving opioid antagonists and enhancing communication between healthcare practitioners and patients regarding opioid use.

Second, Lamont’s proposed budget includes $500,000 to examine various methodologies, including a Medicaid section 1115 demonstration project, to develop and implement a plan to address gaps in the state’s treatment of substance abuse disorders.

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In addition, just in the past month, Connecticut’s congressional delegation announced that the DMHAS is receiving a $5.8 million federal grant that will be used to enhance the state’s efforts to fight the opioid crisis. The funding, which originates from the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA), supplements the first year of the two-year State Opioid Response grant the state received last fall. DMHAS will use the grant to expand access to treatment and recovery support services in Connecticut.

Finally, just a few weeks ago the governor announced new coordinated efforts to confront and prevent the increase in opioid addiction across the state by launching the “LiveLOUD – Live Life with Opioid Use Disorder” statewide awareness campaign, as well as the new Naloxone and Overdose Response (NORA) smartphone app.

Several organizations came out in support of Lamont’s budget proposal. For example, Gian-Carl Casa, president and CEO of Connecticut’s Community Nonprofit Alliance, wrote in a statement: “We also appreciate the Governor’s forward-looking proposal to begin the shift of some state-run mental health services into the community. We urge lawmakers to build upon this proposal by also continuing the effort to move state-operated group homes for people with intellectual and developmental disabilities into the community.”

In the past decade, healthcare services have taken a unique turn in Connecticut due in part to several circumstances. First, the state was one of the first to enroll in Medicaid expansion under the rollout of the Affordable Care Act, boosting insurance coverage to more than 200,000 adults, reported The Connecticut Post.

The expansion, enacted under previous Gov. M. Jodi Rell in 2010, called HUSKY—the state’s public health insurance option—grew dramatically, from covering around 457,529 people in June 2010 to more than 800,000 people today.

Also, following the deadly shootings at Sandy Hook Elementary School in 2012, funding for mental health services got poured into the DMHAS.

Finally, another determining factor was the opioid crisis. According to data from the Centers for Disease Control and Prevention, Connecticut’s increase in overdose deaths 12.8% in 2017, the second-highest increase in New England.

Still, not all parties affected believe privatizing some mental health and substance abuse is the best course for the state.

The president of Connecticut’s largest healthcare workers’ union, David Pickus of SEIU Healthcare 1199 New England said that privatizing state-run services could cause a lot of collateral damage among the state’s most vulnerable populations. Pickus’ union represents 25,000 workers in Connecticut, including 7,000 in state government.

“It is not just so simple to take people out of Southbury, move them to the community and move on,” he stated in a previous article. “These are human beings. It is not just about we’ll cut, we’ll cut, we’ll cut, and nobody gets hurt.”

Rob Baril, president, SEIU 1199, agreed. “The governor’s budget proposal aims to privatize and cut mental health and addiction services. Caregivers have raised concerns that implementing this proposal would break the continuum of care provided to residents in need. Further, the lead agencies that coordinate and manage services in partnership with the private sector would vanish, consolidating public service availability in Danbury and Torrington down to the region of Waterbury. Given a growing opioid crisis in Connecticut, instituting austerity policies at the Department of Mental Health and Addiction Services for our most vulnerable populations will result in higher costs to society in overall expenditures and human suffering.”