Luzerne County and three other counties took a risk in 2006 by teaming up to manage their mental health and addiction treatment funding for low-income residents on Medical Assistance.
If they failed, county taxpayers would have to pay for required services not covered by the fixed allocation of state and federal funding.
But if the combined pot of more than $100 million was spent more efficiently, the state would allow the savings to be used for new programs serving clients who receive the government-funded health care.
An official told a Luzerne County Council committee Tuesday the hoped-for result has happened, with $4.5 million generated for new programs to date.
“We’ve started many programs that would not have been possible without this system,” said James Gallagher, chief executive officer of the Northeast Behavioral Health Care Consortium, the multi-county nonprofit created to manage the funding for Luzerne, Lackawanna, Susquehanna and Wyoming counties.
The consortium oversees $105 million to $110 million in state and federal Medical Assistance behavioral health funding provided to the four counties annually, and more than half — typically 55 percent — is spent on Luzerne County clients, Gallagher said during the Human Services Committee meeting.
About 60 percent of the funding covers outpatient mental health treatment and other services for clients under age 18 across the four counties, he said.
The number of residents receiving Medical Assistance has increased from around 79,000 to 97,000 in the four counties since the consortium’s creation, Gallagher said.
Luzerne County’s clients increased from 43,400 to 54,000 since 2006, he said.
“It’s a sad social commentary,” Councilman Harry Haas said in response to the rising statistics.
Programs and services added with the $4.5 million include:
• Specialized caseworkers to assist clients with both mental health and drug/alcohol disorders, commonly known as “co-occurring disorders.”
• Community-based teams of medical professionals and support workers who try to help high-need clients avoid hospitalization.
• Rental and support services allowing clients with behavioral health issues to live independently.
• A short-stay crisis residential unit in former emergency room space at Wilkes-Barre General Hospital that treats and stabilizes clients so they aren’t admitted to a psychiatric unit, which involves a longer stay and higher cost.
Haas said many county prison inmates have mental health and addiction issues and asked if the Medical Assistance programs help them.
Gallagher said offenders lose Medical Assistance coverage when they are lodged in prison, but the consortium is exploring a possible new treatment and support program upon release when coverage is restored. A program tailored to released inmates would address issues that could cause them to commit more crimes and return to incarceration, he said.
Many counties say prisons have become their “largest mental health program,” Gallagher said.
Some savings materialized by bulk purchasing and figuring out ways to address health concerns before they escalate, he said.
For example, clinical teams were assigned to many schools to help children with mental health and substance abuse concerns, which has reduced out-of-home treatment in more expensive institutions, Gallagher said.
The consortium also agreed to fund proven therapies that involve entire families, as opposed to treating only a child who is struggling to recover in a dysfunctional environment.
The consortium also developed a training program for clients who have completed treatment so they can provide peer support to newcomers overwhelmed by recovery.
“This has been tremendously helpful in getting people engaged in services,” Gallagher said.
Not all changes are driven by finances. Plans are in the works to encourage clients to meet with primary care physicians because research shows people with serious mental illnesses often die 25 years younger than the general population due to physical medical problems, he told the committee.