Joint Labor, Health and Social Services Committee Report
By: Pete Obermueller, Executive Director
Title 25 was the topic of interest on Thursday in Casper. There was no specific legislation discussed, and I did not testify. I attended more as a fail-safe to ensure that I was present if specific county activities needed further clarification from me. The discussion was led by Department of Health Director, Tom Forslund and other Dept. of Health senior staff.
Director Forslund began with a brief overview of the current status of Title 25 patients in the state, as well as an update of the three counties where the majority of Title 25 patients originate. In all of those cases the number of titled patients is down significantly year-to-date over the previous year. However, Laramie County has seen an unexplained spike in titled patients since the beginning of this year. Statewide, the projection for total titled patients is 246, the lowest number of patients in the system since 2013. Despite this, the state is about $250,000 over budget for the biennium and has begun to tap the additional $10 million in contingency funding the legislature granted them. The Department has awarded grants to 13 counties to begin a gatekeeper program, and we have seen early signs that the gatekeeper program is working, though the reduction in titled patients may be attributed to the “Hawthorne effect.” Following is the basic exchange that occurred between the Department and the committee:
Rep. Clem: What are the barriers to centers becoming gatekeepers?
Answer: The legislation does not require gatekeepers, and some county organizations felt like they were moving forward without the need for a grant. Other "frontier" counties felt their numbers were too small to warrant a program. We are seeing some cross county cooperation on this as well.
Sen. Peterson: Did Laramie County apply for a grant, given that their numbers have spiked?
Answer: Yes, but they are a recent applicant and so we have not yet seen how the program will work in Laramie County.
Chairman Barlow: Are we seeing any fruit from our reform efforts over the last couple of years?
Answer: The changes in numbers of patients in each county all have different reasons for those changes. We have some hypotheses as to why those numbers are shifting, but we cannot prove it. Legislative actions are certainly moving us in the right direction, and we have a ribbon cutting ceremony here in Natrona County coming soon on a new counseling center. The key to success is local mental health providers working with community behavioral health centers.
Sen. Peterson: If we are having fewer patients titled, where are the other patients going? I don’t believe the smaller numbers means we have fewer people with needs, and I think that means they are going elsewhere. Who is picking up the slack?
Answer: We are beginning to collect more data on patients that become fully titled that don’t meet “medical necessity.” A number of people are being put into Title 25 for lack of other services available locally, or lack of knowledge of locally based programs. People may need help, but not the level of help the state provides. Sometimes a judge presented with a case may be defaulted into the system for lack of a better option, or knowledge of a better option.
Rep. MacGuire: Is there a means to establish a cost share with local government?
Answer: The law is that the first 72 hours is the responsibility of county government. Natrona County has an arrangement with the Wyoming Medical Center that the WMC pays Title 25 costs, but by and large counties fund the first 72 hours. That is supposed to serve as the incentive to divert patients to local mental health centers.
Rep. Hallinan: Can the legislature require training of judges to divert patients to local mental health organizations instead of to the state?
Answer (from Sen. Scott): We can encourage the courts, and the legislation has provided the courts other options, but we cannot force them.
Sen. Peterson: What are your plans for training and further building up the gatekeeper program?
Answer: We have been focused on getting out the grants to begin the programs. Remember that the gatekeeper program is not a mandate, they should be designed by local entities as opposed to a top down program. Training is important, but we don’t want it to be dictated from the state.