Letter - Can We Have an Honest Conversation?

By Benedict F. Lessing, Jr., MSW, President/CEO, Community Care Alliance

This letter was published by ConvergenceRI on January 3, 2022 as part of an article depicting testimony to the Senate Legislative Commission. The full article can be read here

Ben's Letter

The frustration among providers has been the lack of recognition that community-based organizations as well as residential treatment programs have been in decline financially for the last 20 years – at a minimum.

This has been evidenced in deteriorating infrastructure relative to buildings and IT but, more importantly, in their inability to maintain a workforce that is paid a living and competitive wage.

This deterioration was happening before COVID. That said, with COVID, the system, particularly in terms of the workforce, has begun to unwind at a faster pace.

State agencies and hospital systems, with substantially more money, have been recruiting social workers, counselors, case managers, nurses and other health care professionals away from community-based agencies.

A stark divide

The “disconnect” and lack of understanding between the Governor’s office and R.I. General Assembly is stark, regarding population needs and the role that community organizations play in addressing behavioral health concerns, child welfare, substance use and opioid addiction, homelessness, developmental disabilities – and the recognition that many of these issues are “connected.” This was not always the case.

Testimony regarding the rationale for creating the R.I. Executive Office of Health and Human Services [EOHHS] in 2006 asserted the need for greater fiscal discipline among human services.

Today, there is little evidence that such “fiscal discipline” has occurred, as measured by:

• • Inpatient hospitalization rates and spending
• • Emergency Departments’ boarding of substantial numbers of children that cannot access community-based mental health services
• • Children being placed in residential programs outside of Rhode Island
• • An absence of community-based emergency services programming for children
• • The increasing number of homeless people with serious mental illness
• • Lost wages of parents or other family caregivers due to the absence of a viable social/health care safety net

How to reconfigure R.I. EOHHS

In addition, there are multiple factors at play, including fragmentation, lack of investments and now a raging pandemic. The complexity of human needs is greater than ever.

R.I. EOHHS has become a top down bureaucratic entity. If it remains intact, it must be reconfigured with the following considerations:

• • It must be evaluated based on its ability to reduce fragmentation among state agencies
• • It should not supersede the content expertise that should be provided by state agencies
• • It should support professionalizing state agency leadership positions based on credentials as opposed to political appointees
• • It must be able to assess population needs in coordination with state agencies, community-based organizations and local communities
• • It must be able to have frank conversations with the R.I. General Assembly regarding spending needs and challenges rather than continually focusing on short-term funding cuts
• • It must re-establish meaningful public-private partnerships that contribute to planning, program development and innovation rather than over utilizing external consultants
• • It must actively advocate for staff and infrastructure funding for community-based organizations as part of a broader systems vision to address human services in Rhode Island

Final thoughts

If Rhode Island is going to continue to use Managed Care Organizations [MCOs], the state must develop a new approach to assure accountability, oversight and adherence to a comprehensive vision. Otherwise, the state should discontinue these contracts.
Behavioral health and human services, in general, cannot be solely funded by Medicaid. State dollars must be used to augment funding and innovative services for unique populations, for whom Medicaid does not apply. Emergency services is a good example.

We must keep in mind that budgets become policies that impact people. There are people that are suffering in Rhode Island due to no fault of their own – but because of health care concerns and economic circumstances.

It is long past time for the R.I. General Assembly and the Governor’s office to assert leadership, compassion and common sense in addressing their needs.

Benedict F. Lessing, Jr., MSW, is the president and CEO of Community Care Alliance.