The mental healthcare landscape in Nebraska is being upended by policies for reimbursing providers who see patients covered by both Medicare and Medicaid. Systems say they're losing money, resulting in access gaps for older low-income clients.

Providers say the key concern has to do with serving patients considered dual-eligible, meaning they're enrolled in Medicare and Medicaid. This year, the federal government expanded the scope of professionals who can see Medicare patients for therapy and be reimbursed.

But Jon Day, executive director of Blue Valley Behavioral Health, said because of how Nebraska policy aligns with dual-eligible situations, practitioners are now seeing rates cut in half.

"More providers are coming out and saying, 'Oh my gosh, we can't see these people cause we're losing money.' So, we either refer them out, or they're not taking on people as well," he explained.

Day estimates a $200,000 revenue loss for his system and added that it's not easy to refer clients elsewhere because of provider "deserts" in some areas. Those working with the Nebraska Assocation of Behavioral Health Organizations have been meeting with state Medicaid leaders, noting the state can cover the difference without taking on extra costs. But progress on a final solution has been slow.

Providers say they understand the federal government's desire to bring more mental health professionals to the table in seeing patients. But they add unintended consequences at the state level almost defeat the purpose.

Chase Francl, CEO and president of the Mid-Plains Center for Behavioral Healthcare Services, said this is a heartbreaking situation.

"There's such a low margin on any behavioral health services, and any small disruption really can have catastrophic effects," he said.

Even though fixes offered by these providers are described as solutions without extra costs, they acknowledge the challenging environment given the appetite among elected officials to reduce the state's budget. As for the federal change that brought this situation to light, Licensed Independent Mental Health Practitioners can now be reimbursed under Medicare, and not just those with Masters or doctoral degrees in Social Work.

If you find yourself in a less than festive mood this holiday season, you are not alone.

In Wisconsin, the recent school shooting tragedy in Madison can compound feelings of loneliness and grief already common this time of year.

Mary Kay Battaglia, executive director of the Wisconsin chapter of the National Alliance on Mental Illness, said seeing others celebrating can also contribute to feelings of stress.

"You see everyone around you -- the commercials -- it's festive, right?" Battaglia observed. "Everyone else is festive and sometimes, you're not feeling as festive as what social media or the commercials you're seeing are telling you, you should feel."

NAMI reported three in five Americans feel the holidays negatively affect their mental health. Battaglia encouraged people to create what she calls a "mental health toolkit" filled with key supportive contacts, things bringing them joy and an action plan to use during the holidays.

Adults are encouraged to pay special attention to the young people in their lives this time of year. State data indicate about one-third of young Wisconsinites reported feelings of sadness and hopelessness nearly every day. Battaglia believes it is another sign local communities need to focus more on how to help people reconnect in meaningful ways.

"We've had social media take us to a place that allows us to think we're connecting, but we're not really. We're not connecting with people," Battaglia pointed out. "I think it's really important that youth feel connected in some way that's real and honest, and in person."

For those who don't have friends or family close, Battaglia said the Uplift Wisconsin hotline is open 10 a.m. to 10 p.m. daily and anyone can call if they need someone to talk with. If you are experiencing a mental health crisis, you can call 988 to reach the National Suicide and Crisis Lifeline.

With Christmas less than a week away, experts are giving advice on how seniors and the community can fight against social isolation.

A United Health Foundation report ranked Maryland 27th in the nation for the risk of social isolation to its seniors. One study by AARP found more than 30% of seniors have felt lonely over the past five years during the holidays.

Lois Meszaros, licensed psychologist and executive council member of AARP Maryland, said there are common signs to warn family, friends or seniors themselves they may be experiencing isolation. One of those, she said, is shrinking social circles.

"They're complaining of their world shrinking," Meszaros observed. "They're no longer working, so they're not doing things with coworkers. Friends have moved away to warmer climates or to be closer to grandchildren."

Meszaros pointed out other signs of loneliness include a lack of interest in previously loved activities and unexplainable physical ailments. One example is a senior complaining of a sore arm or leg, despite doctors not being able to find anything wrong.

For anyone who might acutely feel the loneliness of the holidays, Meszaros noted there are ways to fight isolation. She suggested reaching out to family members and friends on the phone or going for walks in the neighborhood. Even if they don't feel like accepting an invitation, Meszaros advised they should go. Look for events at churches, senior centers and libraries.

Some older adults don't seek out help. For family members, friends or neighbors concerned about a senior in their life, Meszaros emphasized there are a number of ways to help them.

"Providing transportation, providing help with technology, I see these as things that are really needed," Meszaros observed.

She added it is helpful for older adults to have technology and learn how to use it, to keep feeling connected with others.

By Amy Felegy for Arts Midwest.
Broadcast version by Mike Moen for Minnesota News Connection reporting for the Arts Midwest-Public News Service Collaboration

Rocky Casillas Aguirre found himself swimming in panic attacks in 2020. He wasn't sleeping; he saw all kinds of therapists and a couple of sleep doctors.

Then, he found meditation.

What followed has transformed Casillas Aguirre's life and career.

"I took refuge in art and meditation and mindfulness practice, all of which I'm now doing full time," the Northfield, Minnesota-based artist says.

With a full eight hours of sleep checked off each night, Casillas Aguirre now spends his time creating-not what-if scenarios in his mind but comic books, short animations, and art with impact.

He's a self-taught graphic designer, comic book writer, and animator with a master's degree in biology. ROKATURAS is Casillas Aguirre's studio-slash-business.

Its personified stars are unlikely friends Twitch and Weenie (read: a relatable flame and a hot dog, with mystical powers of course). They're silly, sure, but they pack a practical punch.

"Twitch flame, he represents the little spark in all of us, like the inner child that lives in all of us who is curious and sees the world with awe and amazement," Casillas Aguirre says.

His children's book Where Did Anxiety Go addresses anxiety symptoms kids might feel. Inside are meditation exercises that ask readers to "breathe in and... breathe out." Characters reiterate "I am safe, there is no need to be scared" in tricky situations.

The themes manifest throughout ROKATURAS's online presence, which caters to a broader age range.

"What are you doing today after work?" an animated pink brain asks into a lime green telephone in a video about burnout Casillas Aguirre posted to his Instagram account.

"Laying down," Twitch responds gravely. "Laying down..."

Doing his P(art)

Casillas Aguirre is a Latino artist from Tijuana, Mexico, where he visits his grandparents often. He says Mexican cultural traditions like Day of the Dead inspire his artwork and ground his sense of self.

"I'm also an LGBTQ artist, or a transgender artist, so the exploration of identity and mental health are things that are really important to me and core to all of the work that I do and the messages that I try to deliver through my art."

Casillas Aguirre says he sees stigma around mental health in his Latino community. It prevents people of all ages from getting help. So he's doing his (p)art-which includes continuing his self-published comic book series. He's also looking to expand production of his video shorts with an animation team.

"In the process of creating art, I was de-stressing and healing myself while simultaneously creating art that is trying to create safe spaces for people to talk about mental health, especially parents with their kids."



Amy Felegy wrote this story for Arts Midwest.