Real people hang in balance when state budget cuts hit human services

From the Sandy Post, Mar 17 2009

It was around Christmas 2007, and Tessa Sieler, who had periodic bouts of mental illness for about eight years, realized she was getting sick again.

She sought a doctor, but none would take a new Medicaid patient. Sieler’s mother, Michelle Veenker, offered to pay, but she was still turned away.

Finally, last May, things got so bad she couldn’t be brushed aside anymore.

“She was suicidal, she was burning out in her yard in a garbage can all her paper items, all her IDs, she was burning her memories,” Veenker said.

When Sieler’s landlord spotted her walking out across Highway 26 without watching for traffic, she called the police.

Sieler, from Sandy, spent three days in a hospital behind a guarded door because she was there involuntarily. She then spent five and a half months in two different treatment facilities. The ordeal cost Sieler her home and months of trauma that could have been avoided.

“Now she’s out and she’s doing OK, but it took us a year and a half and her losing her home,” Veenker said. “And all of that could have been avoided had we been able to find someone who could prescribe her medication when she was willing and able, before she got too sick to comply with medications and treatment.”

That was when times were good.

Now, with recession slamming the state and the country, the future funding of Health and Human Services programs, such as behavioral health support, could be in jeopardy.

A $3.1 billion shortfall

The state is projecting a $3.1 billion budget shortfall for the 2009-2011 biennium, a number that could rise as the recession continues. In December, when the projected shortfall was only $1.2 billion, Gov. Ted Kulongoski sought to close more than that predicted gap with human services cuts. By axing $1.43 billion from the Department of Human Services – $634 million from the state general fund and $789 million in federal funding – he wanted to bolster education funding, his top priority.

Kulongoski’s plan was not to simply cut human services. It was to cut administrative costs and reduce or eliminate certain programs – such as care for seniors and the disabled and dental care for adults on the Oregon Health Plan – and use some of those savings to give all children health care under the Healthy Kids Plan and add 75,000 people to the Oregon Health Plan.

But those improvements required acute cuts to the mental health and addictions department of DHS, including: a 90-percent reduction in outpatient mental health services for non-Medicaid consumers; a 50-percent reduction for acute inpatient care; closing the Blue Mountain Recovery Center, losing 60 state hospital beds; a 50-percent cut for alcohol and drug treatment services for non-Medicaid clients; and eliminating a residential treatment program for non-Medicaid clients.

The governor’s spokeswoman, Anna Richter Taylor, said that budget isn’t even in consideration anymore. Cuts will be larger, and even education and green technology funding, which Kulongoski had hoped to bolster, will likely falter.

Legislators say that while cuts will be necessary, they’re committed to protecting the most vulnerable in society.

“We’ve got a set of core principles that really focus first on protecting services for those who are the neediest,” said Speaker of the House Dave Hunt (D-Gladstone).

So far the Legislature has followed those principles. In the 2007-2009 budget rebalance earlier this year, it reduced a state DHS shortfall of $136.5 million to just $6.3 million by supplying emergency funds and “management actions.”

Hunt also said he’s confident the governor will sign whatever budget the Legislature puts forward.

“His budget was just based on a whole different era of budget realities,” he said. “It’s as though it was decades ago, eons.”

Despite that assurance, many who rely on those services are still scared.

Cuts coming

Those fears are warranted, said Cindy Becker, Clackamas County’s director of the Department of Human Services.

“Here’s the reality: what I’m hearing is the $3 billion shortfall is the floor right now and they’re expecting that to go up,” she said. “So while the specific cuts that the governor outlined may not happen, we will get significant cuts.”

That prospect has kept Veenker awake at night.

“If they cut services and at some point again (my daughter) ends up dropped, if she becomes ill, she’ll end up dead,” Veenker said. “They committed her (in 2007) because she was so disorganized in her thought process that they didn’t think she could manage to get her own food, that she’d die somewhere.”

Veenker and Sieler are far from alone.

Lorayne Dille, 57, was diagnosed in 1975 with bipolar disorder and manic depression. Even after 30 years, she needs support to remain stable.

“I occasionally will have a psychotic break where I lose contact with the world for a few minutes,” she said.

To cope with her condition, she has a number of medications, goes to group sessions weekly, sees a psychiatrist once a month and sees a counselor once a month.

“(Without services) I’d be lost,” she said. “I would feel real vulnerable … I wouldn’t be able to afford my medications.” She said she also could lose her housing, at a supportive group home in Oregon City.

Both Sieler and Dille receive Medicaid, which helps pay for their prescription drugs, counselors and other services.

Under the governor’s initial plan, at least 2,500 Oregonians would have lost services altogether. The income eligibility ceiling for Medicaid would also have dropped, cutting about 4,000 people from their services.

“Basically you’ve decimated the whole service,” Becker said of the behavioral health cuts. “It’s just so stunning. Never in the 30 years that I’ve been in this business have I seen anything like this.”

But until the May budget forecast comes out, no one – not Hunt, not Richter Taylor, and not Becker – knows how the situation will end up.

“I’m not used to saying I don’t know so much, but it’s a really unique situation,” Becker said. “The $3 billion, people were gasping at that, but more and more people are saying, $3 billion, we’ll be lucky with that.”