Rethink the mental health “demonstration” exit plan

Opinion editor’s note: Editorials represent the views of the Star Tribune Editorial Board, which operates independently of the editorial board.


While four members of Gov. Tim Waltz’s cabinet recently announced they will not seek reappointment, one key member of the Commission remains to serve a second term as governor.

Jody Harpstead leads the Minnesota Department of Human Services (DHS). It’s a daunting task with responsibilities that include managing the state’s medical and public assistance programs, as well as the direct care and treatment system.

Harpstead stepped in to lead the agency in August 2019 after allegations of leadership turnover and improper spending roiled the agency. She worked hard to strengthen financial controls and improve broken legislative relations.

The same pragmatic problem-solving is needed again to address the troubling rift between DHS and the state’s mental health community. At issue: the agency’s decision to exit a federal program that pioneered a promising next-generation model of care.

Although an interview this week with DHS suggests the agency is reluctant to reconsider, the editorial board encourages the agency to do so. Harpstead and her behavioral health agency’s top lieutenants also must soon sit down with mental health advocates who say the agency is making the wrong decision, leaving millions in federal funding on the table and not being transparent about its rationale.

The innovative federal program at the heart of the dispute is known as the “National Certified Community Behavioral Health Clinic (CCBHC) Demonstration.”

Among the requirements to be a CCBHC: Crisis services that are available 24 hours a day, seven days a week. In addition, CCBHCs must provide a “comprehensive array of services so that people who need care are not caught trying to get the behavioral health support they need across multiple providers,” according to federal officials.

To do this, CCBHCs must provide core services that include crisis care, screening and risk assessment, treatment planning, outpatient mental health and substance use services, targeted case management, and community-based mental health care for veterans . Also on this list are psychiatric rehabilitation services and “peer, family support and counseling” services.

If it seems like a lot, it is. But that’s the beauty of CCBHC’s approach. It’s a one-stop shop that helps people get quick access to care and better navigate a fragmented care system. This is critical to help people in crisis and ensure they receive ongoing care.

U.S. Sen. Roy Blunt, Republican of Missouri, is an advocate for the CCBHC. His office reports that “Statistics from the Department of Health and Human Services show that people who received services at these clinics had 63.2 percent fewer emergency room visits; spent 60.3% less time in prisons; and have seen a 40.7% reduction in homelessness.”

There are more than 450 CCBHCs across the country. Minnesota, to its credit, was one of the program’s early adopters and currently has 13 CCBHCs, with eight more federal grantees coming online, giving the state a total of 21 “over the next four years,” according to mental health advocates.

As its name suggests, the CCBHC model implementation program and assistance is not intended to be permanent. However, federal lawmakers passed multiple extensions. In 2022, Congress expanded the program and extended funding through fall 2025.

DHS’s decision to leave next month boils down to the state having to “terminate” the program and forgo federal support, with the state’s current huge surplus providing an opportunity to make up for lost federal dollars. Mental health advocates who oppose the decision estimate the state could lose up to $30 million a year in federal funds.

The DHS decision may have come before Congress renewed its commitment to the CCBHC, raising questions about whether this is the right time to “graduate.” The leadership drain at DHS’s Division of Behavioral Health raises additional concerns.

Advocates opposing the DHS decision include some of the state’s most respected mental health organizations — the state chapter of the National Alliance on Mental Illness, the Minnesota Association of Community Health Programs and prominent providers.

“In choosing to remove Minnesota from the demonstration, the state’s national reputation is affected, going from one of the pioneer states in transforming mental health care in the U.S. to a laggard as the rest of the nation seeks to join the demonstration,” the joint statement said. statement.

The gaping divide between DHS and these important voices is troubling and needs fixing. Harpstead is a capable commissioner and should see this as an opportunity for her team to bridge differences and build consensus.

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