HELENA, Mont. 鈥 When the pandemic hit, health officials in Montana鈥檚 Beaverhead County had barely begun to fill a hole left by the 2017 closure of the local public assistance office, mental health clinic, chemical dependency center and job placement office after the state鈥檚 last budget shortfall.
Now, those health officials worry more cuts are coming, even as they brace for a spike in demand for substance abuse and mental health services. That would be no small challenge in a poor farming and ranching region where stigma often prevents people from admitting they need help, said Katherine Buckley-Patton, who chairs the county鈥檚 Mental Health Local Advisory Council.
鈥淚 find it very challenging to find the words that will not make one of my hard-nosed cowboys turn around and walk away,鈥 Buckley-Patton said. 鈥淭hey鈥檙e lonely, they鈥檙e isolated, they鈥檙e depressed, but they鈥檙e not going to call a suicide hotline.鈥
States across the U.S. are still stinging after businesses closed and millions of people lost jobs due to covid-related shutdowns and restrictions. Meanwhile, the pandemic has led to a dramatic increase in the number of people who say their mental health has suffered, (KHN is an editorially independent program of KFF.)
The full extent of the mental health crisis and the demand for behavioral health services may not be known until after the pandemic is over, mental health experts said. That could add costs that budget writers haven鈥檛 anticipated.
鈥淚t usually takes a while before people feel comfortable seeking care from a specialty behavioral health organization,鈥 said , president and CEO of the nonprofit National Council for Behavioral Health in Washington, D.C. 鈥淲e are not likely to see the results of that either in terms of people seeking care 鈥 or suicide rates going up 鈥 until we鈥檙e on the other side of the pandemic.鈥
Last year, states slashed agency budgets, froze pay, furloughed workers, borrowed money and tapped into rainy day funds to make ends meet. Health programs, often among the most expensive part of a state鈥檚 budget, were targeted for cuts in several states even as health officials led efforts to stem the spread of the coronavirus.
This year, the outlook doesn鈥檛 seem quite so bleak due in part to relief packages passed by Congress last spring and in December that buoyed state economies. Another major advantage was that income increased or held steady for people with well-paying jobs and investment income, which boosted states鈥 tax revenues even as millions of lower-income workers were laid off.
鈥淚t has turned out to be not as bad as it might have been in terms of state budgets,鈥 said Mike Leachman, vice president for state fiscal policy for the nonpartisan .
But many states still face cash shortfalls that will be made worse if additional federal aid doesn鈥檛 come, Leachman said. to push through Congress a $1.9 trillion relief package that includes aid to states, while congressional Republicans are proposing a package worth about a third of that amount. States are banking on federal help.
New York Gov. Andrew Cuomo, a Democrat, with spending cuts and tax increases if a fresh round of aid doesn鈥檛 materialize. Some states, such as New Jersey, borrowed to make their budgets whole, and they鈥檙e going to have to start paying that money back. Tourism states such as Hawaii and energy-producing states such as Alaska, Wyoming continue to face grim economic outlooks with oil, gas and coal prices down and tourists cutting back on travel, Leachman said.
Even states with a relatively rosy economic outlook are being cautious. In Colorado, for example, Democratic that restores the cuts made last year to Medicaid and substance abuse programs. But health providers are doubtful the legislature will approve any significant spending increases in this economy.
鈥淓verybody right now is just trying to protect and make sure we don鈥檛 have additional cuts,鈥 said Doyle Forrestal, CEO of the .
That鈥檚 also what Buckley-Patton wants for Montana鈥檚 Beaverhead County, where most of the 9,400 residents live in poverty or earn low incomes.
She led the county鈥檚 effort to recover from the loss in 2017 of a wide range of behavioral health services, along with offices to help poor people receive Medicaid health services, plus cash and food assistance.
Through persuasive grant writing and donations coaxed from elected officials, Buckley-Patton and her team secured office space, equipment and a part-time employee for a resource center that鈥檚 open once a week in the county in the southwestern corner of the state, she said. They also convinced the state health department to send two people every other week on a 120-mile round trip from the Butte office to help county residents with their Medicaid and public assistance applications.
But now Buckley-Patton worries even those modest gains will be threatened in this year鈥檚 budget. Montana is one of the few states with a budget on a two-year cycle, so this is the first time lawmakers have had to craft a spending plan since the pandemic began.
predict healthy tax collections over the next two years.
In January, at the start of the legislative session, the panel in charge of building the state health department鈥檚 budget proposed starting with nearly $1 billion in cuts. The panel鈥檚 chairperson, Republican Rep. , pledged to add back programs and services on their merits during the months-long budget process.
It鈥檚 a strategy Buckley-Patton worries will lead to a net loss of funding for Beaverhead County, which covers more land than Connecticut.
鈥淚 have grave concerns about this legislative session,鈥 she said. 鈥淲e鈥檙e not digging out of the hole; we鈥檙e only going deeper.鈥
Republicans, who are in control of the Montana House, Senate and governor鈥檚 office for the first time in 16 years, are considering reducing the income tax level for the state鈥檚 top earners. Such a measure that could affect state revenue in an uncertain economy has some observers concerned, particularly when an increased need for health services is expected.
鈥淎re legislators committed to building back up that budget in a way that works for communities and for health providers, or are we going to see tax cuts that reduce revenue that put us yet again in another really tight budget?鈥 asked Heather O鈥橪oughlin, co-director of the .
Mary Windecker, executive director of the , said that health providers across the state are still clawing back from more than $100 million in budget cuts in 2017, and that she worries more cuts are on the horizon.
But one bright spot, she said, is a proposal by new Gov. Greg Gianforte, a Republican, to create that would put $23 million a year toward community substance abuse prevention and treatment programs. It would be partially funded by tax revenue the state will receive from recreational marijuana, which voters approved in November, with sales to begin next year.
Windecker cautioned, though, that mental health and substance use are linked, and the governor and lawmakers should plan with that in mind.
鈥淚n the public鈥檚 mind, there鈥檚 drug addicts and there鈥檚 the mentally ill,鈥 she said. 鈥淨uite often, the same people who have a substance use disorder are using it to treat a mental health issue that is underlying that substance use. So, you can never split the two out.鈥
[Correction: This article was updated at 4:45 p.m. ET on Feb. 6 to correct the value of President Joe Biden’s proposed relief package.]
