By Zach Hagadone
For 22 years, North Idaho Children and Community Mental Health has provided a suite of critical resources for children and their families with mental health and developmental needs that they couldn’t otherwise access. Now, according to an announcement Jan. 23, the organization will close its doors in the spring.
“Serving our community, families and clients has not always been easy, but it has been essential,” NICMH stated. “We found great joy to see our clients take new uncharted paths, risks with rewards of providing safety, advocacy and stability within their own family unit.”
NICMH owner Jenny Brotherton-Manna said the closure is due to “a multitude of factors” — most immediate among them the difficulty of hiring and retaining clinicians when the cost of living in Sandpoint has risen to eye-watering levels, as well as both the financial and logistical challenges of working with Medicaid.
“Trying to continue hiring professional people who deserve to be paid a decent wage has become increasingly hard,” she said. “Add that to the cost of living in our part of the world. I have people applying for jobs and finding out how much the rent is in Sandpoint and they can’t do it, so they don’t move here or they don’t stay here — they leave.”
For example, NICMH had 35 employees 10 years ago. That number is down to 23 today, and some of those employees were driving in from Clark Fork and Priest River.
“I’m not sure how much longer some of those people could have held out,” said Brotherton-Manna, who founded NICMH with her late-husband Victor in 2001.
Victor had been a counselor at Sagle Elementary School, until those programs were either severely reduced or outright eliminated in the district. The organization, which has run “on a shoestring” ever since, was intended to “pick up the slack,” Brotherton-Manna said.
While NICMH has never strayed from its core mission to provide mental health and developmental disability services for kids in the community, it grew to include a wide range of programs from therapy to community-based services to peer-counseling for adults.
“Some of those programs were the only ones in town,” Brotherton-Manna said.
Facing closure in the spring, the immediate priority is getting NICMH’s current clients placed with the appropriate service providers.
“We’re looking at a gradual closure and it’s because the needs of the clients need to be triaged,” she said. “If another agency can take [a program], then we’re going to triage them over there. The therapeutic piece, my providers are looking at where they’re going to land — can we land the clients with them? …
“As long as we’re answering phones, we’ll continue to refer people to others in the community,” she added. “I will not shut that off until I know they are all moved somewhere.”
While other providers work with local kids on mental and behavioral health, “seemingly there’s no other organization that works as much with that community as NICMH,” said BGH Behavioral Health Psychologist Joseph Wassif.
“It’s a loss for our community, to put it bluntly,” he said. “They served a very important clientele.”
Brotherton-Manna said NICMH works with about 150 clients at any given time, though that number 10 years ago was closer to 250 — in large part because the organization has had to turn people away due to lack of staffing.
Therapists at other health care organizations will undoubtedly absorb a portion of that need, but the other challenge is that NICMH emphasized working with Medicaid clients — and a shrinking number of providers are willing to take Medicaid, due in part to its low rates but also the onerous amount of paperwork that goes into compliance.
“Managed care in Idaho is the bigger story,” said Jill Hicks, who has served as the clinic director for NICMH for all of its 22 years.
Managed care refers to a system of administering Medicaid benefits and services by contracting their delivery to managed care organizations, the latter which receive a set per-member, per-month payment.
Ideally, managed care is intended to “reduce Medicaid program costs and better manage utilization of health services,” according to the official Medicaid website.
Idaho put in place managed care in 2006, and its behavioral health plan is currently administered by Optum Idaho — part of the larger Optum health services company, which itself is a subsidiary of Minnesota-based UnitedHealth Group.
An Optum Idaho representative told the Reader on Jan. 25 that the company was unaware that NICMH had made the decision to close, and was unfamiliar with the Jan. 23 news release.
“So, at the moment we could not comment about this specific provider, since they are currently in network and in good standing, and have not notified us of any plans to close,” Optum Idaho spokesman Chris Smith wrote in an email.
That said, Smith underlined that Optum does not set Medicaid reimbursement rates or policy — rather, that comes from the Idaho Department of Health and Welfare and federal Centers for Medicare and Medicaid Services.
What’s more, Smith wrote, “Optum Idaho regularly provides information to state and federal Medicaid policy makers to make informed decisions on reimbursement rate amounts, to reduce administrative burden, improve quality and avoid unnecessary costs whenever possible.”
Still, Hicks said managed care brought in “just a ton of paperwork.”
“It’s always been a priority here at NICMH to serve the underserved, so we went through all the hoops to implement managed care and went through all the hoops to maintain our licensure and meet all the audit requirements,” she said.
However, that transformed Medicaid from “kind of an introductory insurance” to an unsustainable time sink. Hicks said she knew of seven practitioners who quit taking Medicaid after implementation of managed care in the state, and that number has only increased.
“It’s just not worth it,” she said. “I could personally see two additional clients a day if I wasn’t swamped in paperwork daily.”
Wassif described it as a “spiral”: when providers give up on the paperwork burden and stop accepting Medicaid, it increases the waiting lists with other practitioners, who then find themselves further strained with trying to balance time spent performing compliance with focus on clients, leading to fewer clients being served, meaning less revenue coming in, meaning still more providers dropping Medicaid and leaving an already underserved population even more vulnerable.
“More and more we have a bigger and bigger problem, with now just really a couple of agencies left that will accept Medicaid,” he said. “It’s going to require going to the state level and saying something’s got to change.”
“That system cannot be sustained, it’s not sustainable,” said Brotherton-Manna.
Though the situation looks grim, Wassif underscored that clients shouldn’t panic amid the many “unknowns” presented by the closure of NICMH.
Likewise, Hicks said, “this town is resilient,” noting that NICMH has been around long enough that it has served multiple generations of the same families.
“I think that a lot of us will continue to work in this community; we feel strongly about this community and its needs,” she added.
Brotherton-Manna said that wherever NICMH’s clients end up receiving services in the community, she’s confident in the quality of care.
“One of my proudest things is that this agency has trained an enormous amount of the workforce,” she said, “so the clients are going to be referred to them.”
“Ultimately, I’m really sad,” said Hicks. “I’m sad for the loss in our community, and I hope my future employment here continues to serve our Medicaid underserved population in some way. …
“It was an honor to meet our clients where they were at, in whatever place they were in their lives,” she added.
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