CRISIS IN THE CLINICS…as demand grows, mental health
facilities dwindle on Long Island
Increasing numbers of
nonprofit mental health clinics on Long Island are closing or being sold to
other mental health networks, following years of declines in government funding
and a growing demand for services.
In the past four years, at
least four clinics have closed in Nassau and Suffolk, including one that has
closed and one about to close this year, and four clinics have been acquired by
other nonprofits.
The closures have prompted
several local social service advocates to ramp up fundraising efforts while
lobbying for increases in government aid. They say treatment options are
dwindling for low- and middle-income patients who earn too much to qualify for
Medicaid.
"There is somewhat of a
crisis in the system," said Jeffrey Steigman, chief administrative officer
of the nonprofit Family Service League, of Huntington, which provides
counseling services for children and families.
In February, the league
acquired the Huntington clinic of Pederson-Krag, a social service agency
founded in 1957. But "it's not just the clinic we took over,"
Steigman said. Mental health agencies "throughout the state are
transferring their licenses or closing clinics because of the financial burden
and the deficits that occur. The fiscal model is broken in certain ways,"
he said.
Currently, there are 18
licensed nonprofit mental health facilities in Nassau and 48 in Suffolk,
according to the State Office of Mental Health Services. The clinics provide
services, including family counseling and drug rehabilitation, for low- and middle-income
residents who cannot afford private care.
More than 10,000 individuals
sought treatment at nonprofit clinics in Nassau last year, according to the
county's Office of Mental Health, Chemical Dependency, and Developmental
Disabilities Services.
Suffolk's Office of Mental
Hygiene said it did not have overall figures. But state data show that nearly
4,000 Suffolk adults and 1,200 children enrolled in Medicaid sought mental
health services in 2013. In Nassau, there were 3,600 adults and 850 children on
Medicaid who received mental health services.
Freeport clinic forced
shut
In May, Catholic Charities
Outpatient Mental Health Clinic in Freeport, which has treated 550 patients a
year, will shutter after more than 50 years in operation. Earlier this year,
the 81-year-old nonprofit Federation Employment and Guidance Services, which
provided mental health services throughout Long Island, announced it was
closing.
The closures came as
Peninsula Counseling Center, a Valley Stream nonprofit founded 102 years ago,
and three clinics operated by Pederson-Krag were acquired by other nonprofit
mental health agencies in recent months, after years of struggling to stay
afloat financially.
Laura A. Cassell, CEO of
Catholic Charities of the Diocese of Rockville Centre, said the organization
decided it no longer could afford to run its Freeport clinic, because of
insufficient reimbursement rates and declining government funding to subsidize
care. Over the past three years, Catholic Charities had to raise $1.26 million
in private donations to keep Freeport open, Cassell said.
"While Catholic
Charities is blessed with generous donations to support our ministries, we
cannot direct such a large portion to just one service site," Cassell
said. "Many other mental health providers were forced to close their doors
for the same reason."
"Unfortunately, with no
hope of permanent additional funding to match the real costs of providing
quality services in the future and increasing unfunded government regulatory
mandates, this painful decision had to be made," Cassell said.
In a newsletter to Long
Island mental health providers last month, Martha A. Carlin, director of the
Long Island field office of the state Office of Mental Health, noted that with
the closures and acquisitions, the "beginning of 2015 has been challenging
for the Long Island region."
Declining reimbursements
Mental health providers say
some of their fiscal strain is due to low reimbursement rates by private
insurers.
Under Medicaid, clinics are
reimbursed an average $130 per visit for an adult patient and $137 for
children, according to state figures.
Commercial insurance
providers pay anywhere from 20 percent to 50 percent less, several local mental
health providers said. Officials with the New York Health Plan Association,
which represents commercial health insurance providers, said they could not
provide data on reimbursement rates because each company negotiates rates with
clinics.
The incentive to treat
higher-paying Medicaid patients means that some clinics are opting to see fewer
patients covered by commercial insurance, said Andrew Malekoff, executive
director of the North Shore Child and Family Guidance Center in Roslyn Heights,
a nonprofit that has about 5,000 clients annually.
Malekoff, who has testified
before state lawmakers about the challenges faced by nonprofit mental health
providers, said that with fewer clinics accepting privately insured patients,
many families who earn too much to qualify for Medicaid are "left with
nowhere to turn for affordable community-based outpatient mental health
care."
The closure of one nonprofit
clinic often causes a ripple effect among the small group of Long Island
nonprofit clinics, where phones are "ringing off the hook," with
queries from displaced patients looking for affordable care, said Jeffrey Friedman,
CEO of Central Nassau Guidance Services in Hicksville.
"As a result of the
closures, we've had an influx of people calling us," Friedman said.
"I think for us the landscape is changing drastically because the
reimbursement from insurance companies is not adequate. We're losing money on
that visit."
Leslie Moran, spokeswoman for
the New York Health Plan Association, said each provider negotiates
reimbursement rates with clinics, aiming to control costs to keep plan rates
down for consumers.
"The reality is, in our
health care system, affordability is something we have to keep an eye on,"
Moran said.
In 2012, the nonprofit Family
& Children's Association, of Mineola, closed its mental health clinics in
Roosevelt and West Hempstead, after years of deficits stemming from services
provided to low-income patients.
Jeffrey Reynolds, executive
director of the association, said losses at both clinics in 2011 totaled $1.6
million. Keeping them open would have "threatened the livelihood" of
other operations, including homeless shelters for seniors and runaways,
Reynolds said.
"What happens when you
lose these clinics is you're driving people into chemical dependency, ERs or
jails," he said.
State taking steps to aid
LI
State Office of Mental Health
spokesman Ben Rosen, to whom Carlin referred questions, said the agency has
"taken several steps to help Long Island's mental health clinics remain
fiscally viable." Rosen said $60 million has been allocated over the next
three years to fiscally distressed clinics statewide, including seven in Nassau
and Suffolk. The clinics, which include the former Pederson-Krag clinics, each
were assigned "strategic planners" to improve their finances over the
next three years, Rosen said.
The agencies acquiring some
of the local facilities say the transition is going as seamlessly as possible.
Herrick Lipton,
administrative and financial director of New Horizon Counseling Center, said
that since taking over Peninsula, the agency has done repair work at the clinic
and installed a flat-screen TV in the waiting room. New Horizon, which also
runs clinics in Ozone Park, East Elmhurst and the Rockaways, also is planning
to add Saturday service hours at Peninsula, Lipton said.
"Peninsula was losing
money, it didn't have the ability to invest in repairs . . . they were in dire
straits," Lipton said. "Our goal is to create a sustainable solution
for mental health services for Nassau County. In today's environment, many
health care providers are struggling to survive."
