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.

Mental health groups are stepping up to help victims of the Los Angeles area wildfires deal with the extreme stress brought on by the disaster.

The California Parent and Youth Helpline is beginning to work at evacuation centers and is looking to partner with community or government entities to provide victims with emotional support.

Lisa Pion-Berlin, president and CEO of Parents Anonymous, which runs the helpline, said people can call, text or live chat with a trained counselor.

"That emotional support really needs to be handled by an experienced professional, who's trained to listen and to help people deal with the immediate angst and depression," Pion-Berlin asserted. "Because they don't know where to turn."

The helpline is open 12 hours a day at 877-427-2736 to guide people through the chaos, desperation and fear. And the group's website caparentyouthhelpline.org will also connect people to ongoing online support groups.

Pion-Berlin pointed out Parents Anonymous would like to expand if fire relief funding becomes available. However, the service may be in jeopardy, because Gov. Gavin Newsom left the helpline out of his January budget proposal.

Now, with entire neighborhoods wiped out, she said the need for mental health assistance is greater than ever.

"Because they no longer have their community. They never don't have their school, they don't have the safe place they lived in," Pion-Berlin outlined. "They're displaced, and the impact is devastating."

Parents Anonymous is asking lawmakers to continue to support the helpline as they negotiate the final budget this spring. The California Parent and Youth Helpline received a two-year appropriation of $4.7 million in the 2023 budget. If it is not renewed, the funding will run out this summer.

The Bipartisan Policy Center has released a new report on reforming the way youth mental health services are delivered, in Michigan and nationwide.

Recommendations from the Youth Mental Health and Substance Abuse Task Force include the need to grow the behavioral health workforce and make it easier for providers to join insurance networks. The report revealed nationwide, teen mental health worsened from 2013 to 2023, with young people reporting feelings of sadness and hopelessness rising from 30% to 40%.

Michele Gazda, health program associate director for the center, shared the thought process behind the recommendations.

"The things that work for adults getting into care may or not work the same for kids and their families," Gazda explained. "Part of what the task force set out to do is make sure that the recommendations were very actionable, that they can be achieved."

The report recommended Congress fund grants of up to $2 million over three years to create 10 regional centers focused on building the behavioral health workforce.

Another recommendation was government agencies should work together to gather better data on young people who are incarcerated and find ways to reduce youth suicide, including in jails, prisons and after release.

Gazda pointed out during the pandemic and the couple of years before, overdose deaths skyrocketed. However, the numbers have since come down and she credited one important change.

"Fortunately during the pandemic, if there's one silver lining, it's that youth mental health has experienced a bit of a destigmatization and folks are much more open and comfortable talking about it than they used to be," Gazda noted. "I think with youth substance use, that's not as much the case."

The task force report also recommended doing more to focus on young people with the most serious mental health needs.


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Thousands of calls to Texas suicide hotlines are going unanswered as funding for call centers is millions of dollars short of what advocates said they need to keep up with demand.

The suicide rate in Texas has grown significantly in the past 20 years and a federal mandate to run the 988 crisis hotline is putting pressure on the system. Mental health advocates said changes to the state and federal system of funding crisis services are urgently needed.

Lyssette Galvan, public policy director for the National Alliance on Mental Illness-Texas, said crisis care needs more respect from the system.

"It's following the successful model of 911 funding," Galvan pointed out. "We're aiming to set up a precedent that 988 should be in parity with 911 and that all emergency services should be treated the same."

A bill filed by state Sen. José Menéndez, D-San Antonio, would create a state trust fund for 988 services similar to how 911 emergency services are handled. Galvan noted the fund, paid by cell phone fees, would expand capacity, increase counselor pay and make the latest technologies available.

Between January and August, 18,500 calls to Texas' 988 system were abandoned. Senate Bill 188, prefiled for the upcoming 89th Texas Legislature, would close the gap for Texans who call a hotline but are put on hold or transferred and cannot talk with a counselor.

"We do have a lot of stakeholder support," Galvan emphasized. "Almost every day I have somebody emailing me and asking me about the bill or if I know about the bill. Even within the local mental health authorities, there's a lot of buy-in."

Galvan added a significant part of the American Rescue Plan Act's funding for the 988 system has expired, and states will need to create permanent financing by the end of 2026.

"As the federal support decreases, it's time for Texans to really step up and ensure that we're helping our fellow neighbor in crisis," Galvan urged. "Our communities deserve nothing less than a complete, accessible, and reliable crisis response system."


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