It's been about a year since the official end of the COVID public health emergency - which has led to a significant drop in Medicaid enrollments and a rise in uninsured individuals in Colorado.

This poses challenges for community mental health centers, like the Jefferson Center for Mental Health, where the rate of Medicaid enrollee decline has surpassed earlier predictions. It has remained below pre-pandemic levels since January.

Dr. Kiara Kuenzler, president and CEO of the Jefferson Center for Mental Health, said it's now facing a daunting $6 million shortfall.

"The people that we're serving are just in extreme stress, struggling to deal with regaining health-care benefits. That impacts not only their access to behavioral health care, but all of their health-care needs," she said.

The nonprofit KFF recognizes the need for behavioral health at an all-time high in its 2023 Colorado fact sheet - identifying more people than ever reporting mental health and substance use challenges.

Kara Johnson-Hufford, Colorado Behavioral Health Care Council CEO, emphasized the urgent need for support for these clinics. She noted a projected shortfall of $24 million to $29 million for these centers overall could mean a risk of reduced services, longer wait times and compromised care.

She added many individuals who have lost Medicaid coverage and now have private insurance are also seeking treatment less frequently - or discontinuing it altogether - due to co-pays and deductibles.

"More people than ever are now going without insurance. No longer qualifying for Medicaid, but cannot afford private insurance - or they may be giving up on Medicaid altogether because of the emotional toll of the enrollment process just being too great," she continued.

Johnson-Hufford predicted if reimbursement mechanisms don't keep pace with the need, programs will close. Despite efforts to address the issue, such as helplines and complaint processes, she said the gap in funding remains a critical concern.

A 2024 study showed almost 26% of Nebraskans reported having a mental-health illness in the past year -- nearly 3% higher than the national average.

Providers and stakeholders of Nebraska's behavioral health care system face uncertainty as more budget cuts loom. In the last legislative session, $15 million was cut from the state's behavioral health services budget and the heads of state government divisions are now being asked to find more cuts.

Tiffany Gressley, regional administrator for Region 3 Behavioral Health Services, questioned how cuts to behavioral health align with Nebraska's conservative values.

"We're being fiscally conservative by serving these people early; as early as we can," Gressley pointed out. "We're saving money and we're saving, on top of that, the human cost that goes along with untreated mental health conditions. "

Gressley explained last year's cut brought the total budget reductions to Nebraska's behavioral health system to nearly $50 million over the past six years, much of it from unfunded provider rate increases. She stressed budget cuts mean fewer Nebraskans receive services.

Among Nebraska counties, 88 of 93 had a shortage of behavioral health providers in 2023, and 29 had none at all. Many rural Nebraskans face considerable challenges accessing behavioral health care, which advocates said further budget cuts will only exacerbate.

Sadie Thompson, chief innovation officer for the Lincoln-based Wellbeing Initiative, an organization providing services for mental health, substance use and chronic physical health conditions, said after a nearly 12% cut to its budget this fiscal year, the organization had to close satellite locations in Fairbury and Geneva and was unable to open one planned for Seward.

"All of these rural communities that we were really starting to see lots of engagement with and impact basically got the rug pulled out and weren't able to continue to have these services," Thompson noted. "These communities don't have services anyway."

Bob Shueey, CEO of South Central Behavioral Services in Hastings and Kearney, said they are constantly looking for qualified therapists and frequently have to turn patients away as a result. Shueey added the state's low provider rate combined with retirements has depleted the state's behavioral health workforce. He argued without attention, the situation will only worsen.

"Even if we raise the rates to a sustainable rate today, it's a multiyear pipeline before someone's even able to start working," Shueey emphasized. "Then that information has to be out there to new students and to young people. 'I'll be able to make my house payment and pay my student loans if I do this; I'm not going to be poor my whole life.'"


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One in four Californians is an immigrant and a new report showed many are refugees who may need mental health services but have trouble finding treatment.

Researchers from the California Pan-Ethnic Health Network found a pressing need for culturally-responsive behavioral health services.

Vincent Chou, community advocacy manager for the group, said many barriers can hinder access.

"These communities face distinct challenges such as trauma from displacement, stress, language barriers, and systemic discrimination," Chou outlined. "All of which contribute to why they're not really utilizing the mental health services that are available to them."

Community groups said they have seen a huge increase in demand for mental health services since the pandemic. The report also called for training on trauma-informed care for providers and county workers who assist immigrants.

Mary Anne Foo, executive director of the Orange County Asian and Pacific Islander Community Alliance, said California faces a dire shortage of bilingual, bicultural mental health providers; people who can better connect with patients.

"When they see a counselor who can speak their language, they're more apt to be able to describe what's going on with them," Foo pointed out. "Or to be able to participate fully in their care."

Ruqayya Ahmad, policy manager for the network, said the state needs to better fund community-based organizations so they can recruit mental health professionals from the populations they serve and offer competitive pay to retain them.

"They're the ones who have these trusted relationships," Ahmad emphasized. "They're helping to normalize mental health conversations and reducing that stigma that exists in some communities."

Vattana Peong, executive director of The Cambodian Family Community Center in Santa Ana, said the state also needs to make it easier for groups like his to get credentialed to accept Medi-Cal insurance.

"There are a lot of barriers for community-based organizations who want to become Medi-Cal mental health providers," Peong stressed. "That is something we need to fix."

He added community groups often offer wraparound services, like child care and transportation, making it easier for low-income families to access health services.

Oregon Health and Science University and Legacy Health have officially submitted merger plans to state regulators. Behavioral therapists at Legacy unionized in anticipation of this to protect themselves.

Sixty behavioral health therapists at Legacy Unity Center for Behavioral Health have voted to join the Oregon Nurses Association.

They're also doubling the size of an existing bargaining unit at the hospital, which includes other mental health workers.

Legacy Behavioral Health Therapist Meaghan Wilkinson-Smith said she and her coworkers didn't know about a potential merger until they heard it on the news.

"It worried people that we were going to continue to have no information," said Wilkinson-Smith, "and just be kind of blindsided by whatever decisions and changes Legacy decided to move forward with."

Wilkinson-Smith said with the union, they hope to have a more standardized pay structure.

ONA and other unions representing workers affected by the merger say they support it, based on assurances from OHSU - including on job security, pay parity, and honoring union contracts.

Access to mental health has been an issue in Oregon. A Mental Health America ranking from 2022 placed the state third to last.

Wilkinson-Smith said the union will help her and her colleagues better advocate for patients.

"We hope that we'll have more of a voice in expressing the things that we think could be helping our patients before they get to a point of needing hospitalization," said Wilkinson-Smith, "but also afterwards, and what that looks like for them."

Wilkinson-Smith also said the union will give them more of a voice in Salem when it comes to state policies.

Along with mental and behavioral health specialists, ONA represents more than 220 nurses at Legacy Unity Center for Behavioral Health.