On a snowy Sunday during Lincoln Sen. Kate Bolz's first year in the Legislature, she was at the Capitol catching up on some work when a young woman came into her office.
The woman had come in to get warm, Bolz said, and asked to use the phone to call family members. When she couldn't reach them, she started to cry, Bolz said.
The woman, the senator learned, was in a mental health crisis, and so Bolz drove her to get medical help.
"I'm so grateful that those providers were there to help that young woman in her moment of need," she said.
Bolz was speaking at a news conference, along with 60 behavioral health providers, to advocate for a bill (LB327) that would increase by 5 percent each of the next two years the Medicaid and Probation Administration service provider rates paid for mental health services and substance abuse treatment.
The woman's story reminded her that if Nebraska doesn't adequately address behavioral health, "it will come walking in and knocking on our door, and we will be required to pay more attention to it."
Too many people go without the necessary care, Bolz said.
A study by the behavioral health division of the Department of Health and Human Services showed rates paid to providers is from 7 percent to 35 percent below the actual cost of providing the services.
But Gov. Pete Ricketts' budget proposal recommended a 2 percent increase for long-term care services only. The Legislature's preliminary budget recommended 2 percent increases across the board for Medicaid providers, including physicians, hospitals and nursing homes.
Bolz's bill to get providers the reimbursements they need will have a hearing March 26 in front of the Appropriations Committee.
Nationally, and in Nebraska, about 62 percent of mental health providers and 69 percent of substance abuse providers rely on funding from public sources like Medicaid, according to Annette Dubas, executive director of the Nebraska Association of Behavioral Health Organizations.
"We cannot continue to sustain quality efforts at rates that are less than what it costs to do business," said Topher Hansen, executive director of CenterPointe, which provides addiction and mental health treatment. "We are relying on charitable people in our community to make up the difference. … It's not the way to run a good system."
The last thing a great community wants is a fragile behavioral health system, he said.
At CenterPointe this year, he said, they will serve about 3,200 people, about 30 percent of whom are Medicaid clients. Three years ago, when managed care came in, the providers all went down to base Medicaid rates and have not increased rates since then.
Mary Barry-Magsamen, chief executive officer of St. Monica's, which offers addiction recovery services for women, said when she started at the nonprofit years ago, fundraising wasn't a part of the mission.
"And today almost all of us have staff that are dedicated just to fundraising because that gap has grown so large. In order to survive we've had to become development experts, which is not what we got into the business to do," she said.
The lack of rate increases over the years has led to more than 25 providers in the state closing, said Pat Connell, vice president for behavioral health for Boys Town National Research Hospital.
"It makes it very difficult to recruit mental health professionals to move into the state of Nebraska because we cannot pay competitive rates that they're getting in other states, the salaries that they're getting," Connell said.
Nearly one in five Nebraskans have a mental illness, but 88 of Nebraska's 93 counties are designated as federal mental health professional shortage areas, said Andy Hale, vice president for advocacy for the Nebraska Hospital Association. Seventy-eight counties have no practicing psychiatrists and 32 counties have no behavioral health provider of any kind.
"When people suffer from behavioral health issues and have nowhere to go, they end up in our emergency departments and they end up in our jails," Hale said.
Lincoln police officers were called to incidents 3,900 times in 2018 because someone was in a mental health crisis. That number has gone up every year since 2012, said Lincoln Police Chief Jeff Bliemeister.
Officers have special training but are dependent on providers to support them and those people who need help.
"When our response stops, we can turn that over (to those providers) so maybe the quality of life of the individuals that are struggling and their family members can improve," he said.