Behavioral-health providers in Pennsylvania face financial instability because of inconsistent rate increases, affecting staff recruitment and retention.

In a survey from the Pennsylvania Council of Children, Youth and Family Services, one provider stated when increases occur, 70% goes to salaries, 20% to occupancy, and 10% to insurance.

Nancy Kukovich, CEO of the nonprofit youth services provider Adelphoi, recommended improved Behavioral Health Managed Care Organizations review processes for rate increase requests, citing insufficient state oversight over the rate request process.

She said their evidence-based multisystemic therapy is in need of a master's degree-level therapist, but due to lack of funding it's been difficult to recruit for this position.

"Its general claim to fame is behavioral health, but it is intense enough that it can keep kids out of the deeper end of the system," Kukovich explained. "They don't have to go to residential. They can get this really intensive service in their home. So, it's of great value to some of the counties, but it's not an inexpensive program."

The survey found Behavioral Health Managed Care Organizations sometimes offer increases during fund surpluses or when federal funds, such as the American Rescue Plan Act, are available. But the raises have not kept pace with providers' budget needs because of market competition and years of minimal increases.

Kukovich pointed out Adelphoi works with five Behavioral Health Managed-Care Organizations and has not received a rate increase in years. She noted they request the rate increase from the organizations and before approving an increase, they typically request information from providers to determine the value of the program.

"They go through a big process of trying to figure out, do we have enough of the service already? Do we need more of it? Is it something that's really important?," Kukovich outlined. "Then we usually have to fill out a whole lot of paperwork about what our costs are, what salaries look like, etc. We submit that information. We find out whether or not we get a rate increase."

Amy Fenn, senior director of Pennsylvania community-based services for Pittsburgh-based provider Pressley Ridge, oversees a variety of programs, including in-home mental health, child welfare, juvenile justice and others. She said the inconsistent rate increases ultimately affects their ability to attract and retain quality staff.

"The main thing is always salaries, because we give merit increases every year," Fenn emphasized. "Without rate increases, we're continuing to have higher costs but we still never feel like we can pay people as much as we as we should be, paying them as much as the work is worth, because without those regular rate increases, we just can't keep up with the expenses."

The survey shows behavioral health providers are competing with school-based jobs offering better pay and hours. To stay competitive, providers have raised salaries by up to 11%, despite limited funding. It recommends linking salary increases to actual costs and exploring flexibility within Behavioral Health Managed Care Organizations.


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A new report found Connecticut's fiscal controls on the state budget restrict long-term growth.

The controls were introduced during the 2018 budget year to stabilize the budget and long-term controls but since their implementation, the budget surplus total grew to more than $12 billion, which observers said means they are twice as restrictive as they are supposed to be.

Patrick O'Brien, research and policy director at Connecticut Voices for Children, said there is a better way for the budget controls to work.

"We make the case for a more balanced approach," O'Brien explained. "One that maintains fiscal discipline while introducing the flexibility necessary to fund current needs and make public investments essential to supporting families and children, and growing the state's economy."

Reforming the fiscal controls involves changing the state's revenue and spending caps. In practice, the state needs a well-designed volatility cap since personal income and entity taxes are highly volatile. But the current cap's threshold was set too low and is indexed to a variable with no meaningful connection to the taxes, which created up to $755 million per year in restricted revenue, or more than $5 billion between 2018 and 2024.

Making changes to the caps would result in more reasonable restrictions on the collected funds. The report noted Connecticut's spending controls are beneficial. But because personal income growth is slower than the nation, it is limited economic growth.

O'Brien argued the spending cap could have created more revenue.

"If the state's spending cap had continued adjusting since fiscal year 2018 based on the original inflation index rather than a narrower index but excludes food and energy," O'Brien emphasized. "Which has made the spending cap excessively restrictive."

The report also found adjusting the budget reserve fund allows the funds to be used for services beyond debt reduction, like programs to help the state's children and families.

The Internal Revenue Service will be in the crosshairs in the second Trump administration, as the president-elect's recently announced choice to run the agency has called for it to be abolished.

Former Missouri Congressman Billy Long, Trump's choice for IRS Commissioner, cosponsored a bill to get rid of the IRS and implement a national sales tax in its place.

Ryan Polk, assistant professor of accountancy at Clemson University, said if the new administration starts laying off IRS workers, taxpayers and businesses in California and across the U.S. would see big delays.

"When you defund or reduce the funding at the IRS, you run the risk of a less helpful IRS," Polk contended. "The average, everyday taxpayer might be worse off when they have a question."

During the Biden administration, the IRS got an $80 billion boost in funding from the Inflation Reduction Act and used it to overhaul old computer systems and add agents, raising its phone call response rate from an abysmal 15% to over 80%. And the agency added a portal allowing people to upload documents instead of mailing them.

The IRS also debuted Direct File, a system allowing people to file their federal income taxes without paying a tax preparer, available in California and 22 other states. Polk argued the new Congress should understand cutting the IRS budget will limit its ability to pay for the administration's priorities.

"Just last year, they audited taxpayers and collected 100 additional billion dollars that wouldn't otherwise have been collected," Polk pointed out. "That's a pretty significant amount of money. It can go a long way, depending on regardless of the government program or tax cut you're trying to get through."

The IRS said it collects $100 in revenue for every 34 cents it spends on enforcement. Conservative critics of the agency alleged it has been weaponized, with some audits being targeted for political reasons.


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The word "fraud" is likely to circulate in the upcoming Minnesota legislative session. One political expert said state agencies are being targeted but the response requires careful thought.

The recent Feeding our Future scandal has spurred demand for more oversight of government spending in Minnesota. There are renewed concerns about organizations claiming to provide various medical services but engage in phony Medicaid billing.

Tim Lindberg, associate professor of political science at the University of Minnesota-Morris, said larger entities are making a more coordinated effort to defraud key agencies. He pointed out it mirrors global crime rings preying on consumers.

"There is some legitimate concern out there but it is also a global phenomenon that is increasing in size and importance," Lindberg observed. "I think government from the top down needs to sort of figure out a new way to deal with this."

Lindberg pointed out the state has investigative resources and internal controls but he thinks the public sector at large likely has some outdated monitoring approaches, especially as technology evolves. He argued it is important to remember agencies in the spotlight are helping people in need who are not part of these scams, and even with the best controls, completely eliminating fraud is impossible.

The cases have garnered headlines and since Democrats have the upper hand in controlling Minnesota government, Lindberg predicted Republicans will use the trend as part of their push for restrictions or cutbacks. He believes Democrats might agree to certain moves to win back public trust but stressed fraud against government is not a partisan issue.

"People doing these frauds, they don't care who's in office," Lindberg asserted. "They don't care who's in power. And Republicans and Democrats themselves have been in various levels, in various states, overseeing governments where this happens."

Taxpayer dollars are at the center of what's happening. Lindberg added the private sector must also mitigate fraud with steps like major retailers locking up essential items in cases. He suggested lawmakers have to avoid veering off-path.

"What are these ways in which government can work better, more efficiently, but also not eliminate the benefits that these programs are designed to do?" Lindberg asked.


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