How helping the poor could fill a major gap in North Dakota’s mental health system – InForum

FARGO — North Dakota’s largest providers of private inpatient and substance abuse treatment say they’re financially bleed out from serving the sickest patients who can’t afford it.

ShareHouse president Ty Hegland said ShareHouse, the state’s largest provider of inpatient substance use disorder treatment, has seen an increase in the number and severity of cases during the pandemic.

“We’re hitting sharply right now,” he said. “We must act now. If we don’t, we’ll pile up the bodies.”

Prairie St. in Fargo, the state’s largest private psychiatric hospital. John’s was forced to close its 48-bed inpatient substance use disorder treatment program due to insufficient funding for patients with no insurance or other means of paying for services.

Prairie St. “There are patients who are not being served,” said Jeff Herman, president of John’s. “We can no longer provide this service for free” after years of running the program without adequate payment.

The two behavioral health administrators will go to the North Dakota Legislature with priority requests to improve access to treatment for those needing psychiatric or substance abuse care.

For several years, North Dakota has provided coupons to pay for substance use disorder treatment for those without insurance or the ability to pay. But providers say gaps in service remain. To address this issue, behavioral health providers will be pleading for more funding for reimbursements through the expansion of Medicaid and Medicaid, the health insurance program for the poor.

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One important request: The North Dakota Department of Human Services has filed for a waiver to allow reimbursement for adult Medicaid patients serving in “mental illness institutions” with more than 16 beds.

Under a 1965 law, Medicaid will not pay for substance use disorder or psychiatric treatment in any treatment center or hospital with more than 16 beds.

In 2021, the North Dakota Legislature authorized a waiver application, but state officials have yet to initiate the long and complex process.

Earlier this year, a state human services executive told legislators that filing for a waiver would likely take three to five years, require five full-time employees, and cost an estimated $3.5 million.

In North Dakota, the term “mental illness institutions” used in the federal law of 1965 with more than 16 beds is the State Hospital in Jamestown, which has 140 licensed beds; The 110-bed Prairie St. John’s has 132 beds when its new hospital opens on January 10; ShareHouse in Fargo with 87 beds; and the 36-bed Summit Prairie Recovery Center in Raleigh.

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Hegland said the purpose of the exemption is to ensure that the sickest among the needy in the state receive treatment.

ShareHouse said between 30 and 50 percent of its patients use Medicaid. “How do they access services?”

The answer is to raise funds to make beds that are already available for adult Medicaid patients, Hegland said: “We have enough beds.” “We don’t have the right beds.”

Legislators have expressed concern that the impact of securing Medicaid exemptions should be budget-independent; this is a difficult hurdle to reach as the goal will be to serve more people.

But Hegland says 39 states, including Minnesota, have received waivers or have pending waiver applications.

“If 39 other states can do that, what are we missing?” He asked.

“Are they really much smarter than we are?” Herman asked. he added.

By failing to get the Medicaid exemption, Hegland said North Dakota was giving up federal funds that could help people. “We leave money on the table,” he said, adding that he believes the application will cost North Dakota $1.5 to $3 million, relative to other states’ costs.

Private providers offer philanthropy when patients can’t pay. This means their ability to reinvest to expand or upgrade services to meet the region’s needs has diminished, Hegland said.

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Herman, Prairie St. John’s owner said the United Health Services of Pennsylvania has invested $48 million to build the new 132-bed hospital.

A backhoe and several stacks of pallets stand outside a new, rectangular building.

The new Prairie St. John’s Hospital is under construction.

David Samson / Forum

“How much should my company invest in the state of North Dakota,” Herman said, if the state isn’t willing to pay to expand behavioral health care for the needy. In the past two years, Prairie St. He said John’s had a “$2 million negative impact” that made it difficult to maintain services.

Hegland said that unless the state pursues a Medicaid waiver, it should create a voucher program to pay as a last resort for adults who can’t afford treatment.

North Dakota faces a severe shortage of recognized behavioral health professionals, and providers hope the government can invest in supporting workforce development in this area.

“Basically, our labor pool is flat,” Hegland said. “It will be a tough fight”

Herman said he doesn’t see a plan to make up for the lack of behavioral health workers.

Fortunately, Hegland said, behavioral health has won “legislative champions.”

I think we will have a very dynamic session.” “We need to make some bold attempts.”


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