February 22, 2006

By CYDNEY GILLIS
Staff Reporter

After years of budget cuts, a state surplus of $1.4 billion has raised hopes that the legislature will restore services for the homeless, disabled, and working poor in 2006.

For “Mrs. W,” a mentally ill immigrant who lives in Seattle’s Chinatown district, the help can’t come soon enough.

On Jan. 1, in the wake of some behind-the-scenes rebudgeting last year at the state, King County pulled the plug on outpatient services for Mrs. W and about 600 other mentally ill people who don’t receive or aren’t eligible for Medicaid.

The county says it was forced to cut the services because it didn’t get $7.4 million it expected in state funding last year. The money would have paid the bills for non-Medicaid patients who receive services at 18 county-funded mental health clinics, including Seattle Mental Health, Community Psychiatric Clinic, and Asian Counseling and Referral Services, the agency that looks after Mrs. W.

Yoon Joo Han, director of behavioral health at Asian Counseling, says Mrs. W is a paranoid schizophrenic who came from China in 1979. She suffers from cataracts and a belief that her blurred vision is due to poisoned water that she washed her face with. She can’t get Medicaid because two years ago she lost her Social Security card and passport.

Mrs. W isn’t alone. Even if they have identification, Han says many mentally ill patients — particularly among the homeless — are so delusional or incapacitated that they can’t fill out the Medicaid paperwork. Young people experiencing their first psychotic episode have no medical history to qualify for Medicaid. Others haven’t been in the United States long enough to become citizens.

Han points out that doesn’t make the effects of their symptoms or psychosis any less severe for them — or the community.

“ These people don’t have any resources --— no insurance, no money, no Medicaid. They will end up in the hospital, the jail, or the morgue,” she says. “Eventually, it will cost the system and the community more. It’s really shortsighted to cut off outpatient services.”

It’s also “institutionalized racism,” Han says. “The fact is that a higher percentage of people of color are being shut [out] of the only option they have for mental health.”

Han says Asian Counseling currently serves about 100 non-Medicaid clients. They will be cut off one by one as their state-paid benefit — one year of mental health services — expires. That day is coming soon for Mrs. W.

After that, says Amnon Shoenfeld, director of King County’s mental health program, “If you’re not on Medicaid, you can’t get served in our public-funded system” — unless it’s a breakdown that requires hospitalization. Even then, he says, there will be no follow-up care.

Shoenfeld hopes the legislature will make up the $7.4 million shortfall, which he says follows six years of budget reductions for the county’s mental health system.

Last year, the legislature voted an extra $80 million for state mental health services to make up for a loss of federal Medicaid dollars, which the government told states they could no longer use for people such as Mrs. W.

The legislature directed that $35 million of the money go to mental health services based on population, with King County originally slated to get about $31 million. Instead, Shoenfeld says, the state Mental Health Division carved out $25 million and divided it among the state’s 11 smallest mental health provider networks.

As a result, he says, the three counties with the largest populations and mental health systems — King, Pierce, and Spokane — were shorted millions of dollars.

In September, faced with a $7.5 million shortfall, Spokane County cut off funding for its non-Medicaid patients. In the wake of the cuts, The Spokesman Review reported a layoff of 65 workers at Spokane Mental Health.

While the big counties make cuts, Shoenfeld says the state’s rural regions ended up with more money than they can spend. That’s because most of their patients qualify for Medicaid, he says.

“ They can serve anyone in Chelan County or Douglas County or Richland or Aberdeen who’s not on Medicaid. In King County, we can’t anymore,” Shoenfeld says. “It’s extremely unjust. It doesn’t make sense.”

Dave Daniels, operations chief for the Mental Health Division, said the redistribution was done after an acturial study showed that the legislature’s allocation formula would have wiped out the budgets of the state’s rural mental health systems.

He adds that the division consulted the governor and key legislators before making the adjustment and says it’s a “cheap shot” for King County officials to blame the division.

“ We care as much as they do,” Daniels says, but “we have to look at the whole state.”