David Mineta chokes up when speaking in regards to the roughly 1,500 people Momentum for Well being — the nonprofit he runs — gained’t be capable of assist this coming 12 months.
Momentum is without doubt one of the largest nonprofit behavioral well being service suppliers in Santa Clara County, serving greater than 4,000 adults and kids yearly. However due to ripple results from CalAIM — a multi-year plan to overtake California’s Medi-Cal system — the nonprofit stated it closed six of its packages and laid off 85 employees members on the finish of December.
“It simply breaks me,” stated Mineta, the president and CEO of Momentum.
California Advancing and Innovating Medi-Cal, or CalAIM for brief, was touted by Gov. Gavin Newsom as a “once-in-a-generation” alternative to remodel the state’s Medicaid system, which covers greater than one-third of Californians. Launched in 2022, CalAIM will refocus Medi-Cal over the course of 5 years to extra of what’s referred to as a “complete individual strategy” that higher integrates bodily well being, behavioral well being and social providers for low earnings residents.
CalAIM’s newest modifications went into impact July 1 and dramatically reformed how organizations like Momentum invoice for providers and get reimbursed. Whereas these suppliers used to get reimbursed for the precise prices of offering providers, the brand new system solely reimburses for a standardized set charge for every service. In consequence, during the last six months, behavioral healthcare suppliers throughout the state have struggled to financially preserve extra community-oriented providers that put docs, social employees and case managers out within the area — providers which may not be utterly coated by the brand new standardized mannequin.
At Momentum, Mineta stated they only couldn’t maintain all of the pink ink triggered by the cost reform. The choice to finish sure outpatient habit packages and different intensive psychological well being providers, in addition to scale back the nonprofit’s employees by 15% clearly weighs on the longtime social employee. He stated it’s exhausting for him to even speak about it.
“That is the largest factor I’ll ever do in my profession is getting by means of this,” Mineta stated.
Elisa Koff-Ginsborg, the chief director of the Behavioral Well being Contractors’ Affiliation of Santa Clara County, referred to as the most recent modifications “essentially the most seismic shift within the behavioral well being system in over half a century.”
The affiliation represents 30 nonprofits that make up 90 % of the behavioral well being providers that Santa Clara County offers. Koff-Ginsborg stated Momentum isn’t the one supplier reeling from the consequences of CalAIM — a latest survey carried out by the affiliation discovered that of the 18 companies within the county that responded, 16 had considerably misplaced cash within the final six months.
“It treats all of the packages the identical,” Koff-Ginsborg stated of CalAIM. “The hazard of that long run is it incentivizes suppliers to solely maintain the providers that can cowl their prices and the providers that don’t are sometimes those people who’re served by means of the protection internet actually need.”
She referred to as the brand new reforms a “one dimension suits all clinic-based mannequin” that favors people who’re in a position to come into an workplace and discourages companies from serving populations that lack transportation, distrust establishments or who’re coping with complicated points.
For Candace DeCou, Momentum closing packages and shedding employees is “horrifying.” Her 44-year-old son, Graydon, has struggled with extreme drug habit for greater than half his life. However beneath the care of Momentum, she’s began to see a “glimmer of hope.”
“What’s the reply to that for the time being if you assume there is perhaps hope on the horizon?” she stated of the brand new CalAIM modifications. “If Momentum or another community-based group closes their doorways, they’ll simply take their present shoppers and attempt to push them someplace else. We already are missing sources to even preserve among the present packages.”
DeCou — who serves on the county’s behavioral well being board — stated whereas her son’s program isn’t closing, she’s frightened in regards to the impacts it is going to have on present employees at Momentum and whether or not it is going to jeopardize her son’s care. She’s additionally alarmed that different behavioral healthcare suppliers additionally is perhaps in danger.
“They’re the one who appears to be making a distinction for my son proper now,” she stated. “However there’s one other group someplace else that could be serving to any person else’s son and that’s all a mom can hope for.”
In December, the Santa Clara County Board of Supervisors took motion to ensure no extra behavioral well being suppliers they contract with have to shut packages.
“The county is dedicated to creating certain that we don’t lose a single consumer that we’re serving,” Board President Susan Ellenberg advised The Mercury Information. “It might be that different packages have to choose up these sufferers, however the dedication is totally to proceed to serve those self same shoppers.”
The county is at the moment reviewing modifying its personal charge constructions to make sure psychological well being and substance use suppliers are reimbursed correctly.
With out the county stepping in, Christophe Rebboah, the CEO of Rebekah Kids’s Providers in Campbell, frightened they might endure an analogous destiny as Momentum. The company was taking a look at shedding 1 / 4 of its employees as a result of monetary hit it’s taken the final six months — a transfer that might affect a whole bunch of youngsters and households.
“We serve these most susceptible, these most in want and that’s one thing that shouldn’t be compromised and can’t be compromised,” he stated.
Mineta acknowledges that any change the county makes gained’t save the six packages Momentum has already misplaced, however he does hope it helps the general system transferring ahead. Because the nonprofit enters into the brand new 12 months with much less employees, he stated they’re making an attempt to restructure to allow them to be as efficient as potential for shoppers.
“The information is fairly clear,” Mineta stated. “Behavioral well being is the second pandemic. We’re in it and we’re going to be in it for some time. It’s crucial that we get CalAIM proper.”