When the Washington Legislature and Gov. Chris Gregoire finally agreed on a bare-bones state budget for the next two years, they agreed on something else as well: It was a crappy experience, but hey, now the deed was done, and after 135 days of leg-wrestling and eye-gouging, they finally got to go home. Whew!
So how did things wind up for health programs in Washington State?
“It’s going to be a challenge. I don’t want to minimize the fact that the cuts will be felt,” says David Dickinson, director of DSHS’s Division of Behavioral Health and Recovery.
“Overall, the total changes for mental health for the biennium … we’re down about $57 million. That’s statewide. I can’t even say what that means for Spokane,” says David Panken, CEO of Spokane Mental Health.
“On the positive: It appears that our developmental disability services and programs will not be reduced significantly … that’s wonderful to see,” says Christine Barada, director of Spokane County Community Services, the Regional Support Network that disburses state funding for mental health, disability and dependency programs.
So the best light on the new budget is that the cuts in some areas for vulnerable people haven’t been as bad as they might have been.
“What is the metaphor I’m seeking?” Dickinson asks from Olympia. “It’s like you’re holding a foam ball and you squeeze it in one area and another area kind of bubbles out. When you only have X amount of dollars and X amount of capacity and if there are more people needing services when less services are available — where that foam ball bubbles out is in the jails and in the local hospitals, and it will show up on your streets. You will see more evidence of homelessness.”
The cuts are tough, but all three officials note that all state departments were hit in the new budget. They note the new biennial budget comes hard on the heels of emergency across-the-board cuts last fall. And locally, Panken and Barada say, it may take months before all the reductions shake out.
One of the biggest chunks taken out of the social services side of the budget was a $180 million reduction in the Disability Lifeline, which serves the poorest in the state. The cutback eliminates cash grants that were often used for rent in subsidized apartments, replacing it with a housing voucher program.
The Disability Lifeline clients often also experience health problems as well as addictions and mental health issues. They are likely to be buffeted by several layers of new budget cuts.
In mental health emergencies, Eastern State Hospital still offers eight beds to the community but is losing 29.2 FTEs (full-time equivalent jobs), says DSHS spokesman John Wiley. The staff cuts appear likely to be absorbed by attrition — not filling jobs after retirements or other departures, Wiley says. But it still means fewer staffers to cover the workload.
Also, the Spokane County Regional Support Network is having community mental health funding cut by 25 percent. “It makes less money available to RSNs to find alternatives [to Eastern State] treatment for their patients, such as at the Foothills facility…” or other community crisis beds, Wiley writes in a follow-up e-mail. “What that will mean in the long run is still being discussed.”
“It’s really going to take some time to find out what those reductions will mean for us, specifically,” says Barada of the county RSN. Statewide, the Regional Support Networks are having mental health funding cut by $17 million. Substance-abuse programs statewide are being reduced by $7 million, she adds.
Panken, of Spokane Mental Health, has been crunching numbers and notes the staffi ng reductions at Eastern State Hospital translate into $3.6 million, the local RSN is down $8.7 million, and there’s a $17.5 million reduction in Medicaid. The 25 percent reduction in crisis diversion that Wiley mentioned amounts to $750,000 for the biennium.
“The county has been fiscally conservative, so for the next year it should be absorbable without cutting any services,” Panken says. “But we have to get the fi nal numbers from the state to know what that’s going to look like.”
Dickinson says one of the other major cuts came by restricting Medicaid eligibility. This comes with a hidden cut, he notes. The federal government matches state Medicaid, “so when you take money out of Medicaid at $7.5 million or $8 million, it doubles the reduction because you lose the federal match,” Dickinson says.
He also notes the reductions are not all coming out of services. All state workers, Dickinson says, are taking a 3 percent pay cut, jobs are being eliminated and the state’s premier pension plan is also having reductions in cost-of-living allowances.
“Everybody’s taking hits,” he says.