Two years after Chicago Mayor Rahm Emanuel shut down half of the city’s mental health clinics, the Mental Health Movement is charging that the city “is sabotaging its remaining services by refusing to serve people getting health benefits through the Affordable Care Act.”
Tens of thousands of Chicagoans signed up for CountyCare, Cook County’s early rollout of ACA’s Medicaid expansion, but the city chose not to join the CountyCare network.
A health department spokesman told the Tribune last month that current clients who enroll in Medicaid will be able to keep seeing their therapists. But a clinic staff member told me recently he’d been instructed not to accept CountyCare enrollees as new patients and to transfer patients who joined CountyCare to private providers.
“The city is pushing people out and they’re not following up to see if they are getting care,” said N’Dana Carter of the MHM. “They just want them out of the clinics.”
“A lot of people are just out there,” she said. Carter launched an online petition drive calling on the city to join the CountyCare network.
A health department spokesman didn’t respond to a request for comment, but the city has said it plans to focus on serving uninsured patients. With the advent of the ACA, they will mostly come from among Chicago’s 100,000 undocumented residents.
The assumption is that the expansion of Medicaid funding will spur nonprofit community clinics to expand to areas that are now badly underserved, particularly the South and West Sides. But that assumption may be premature. Several nonprofit mental health leaders told the Tribune that it remains to be seen whether there will be enough providers — particularly given the high levels of mental health needs found in early CountyCare enrollees — and whether underserved communities will be adequately reached.
Nonprofit agencies are hobbled by low reimbursement rates and long delays in payment from the state and heavy cuts in the state budget have taken their toll. When the city closed six of its clinics in 2012, two nonprofit mental health services still went out of business despite the increased need — Community Mental Health Council Inc. on the South Side and the Counseling Center of Lakeview on the North Side.
The extent of unmet mental health needs is vast, and you might think an “all hands on deck” approach would be justified. Pro Publica recently reported that researchers found 43 percent of patients at John H. Stroger Jr. Hospital’s trauma center showed signs of PTSD. Last year a WBEZ report underscored the link between street violence by young people and domestic violence they’d experienced or witnessed as children.
MHM members witnessed a revealing episode last month as they travelled to a meeting, Carter said. The Red Line was shut down and passengers herded onto shuttle buses after a man on the 79th Street platform threatened suicide. It was just a few blocks from one of the city clinics shuttered two years ago, she said.
Public clinics are a necessary part of the safety net and are needed to fill gaps in coverage by the patchwork of private providers, advocates say. There’s also a huge role they could play in community education around mental health issues — not just through advertising billboards on buses, but clinicians and educators reaching people at schools and churches.
Instead of committing to maintaining its network of clinics, the city is turning down revenue by turning away insured patients. It looks a lot like privatization by slow strangulation. And it’s happening with little public debate.
The MHM is holding a town hall meeting on Thursday, February 27 at 6 p.m. at UE Hall, 37 S. Ashland. Mayor Emanuel, County Board President Preckwinkle, and aldermen and health officials have been invited.