What would Gov. Evers' proposed $500 million for mental health accomplish? Here are three key issues.

In the weeks following Gov. Tony Evers declaring 2023 "The Year of Mental Health" at the State of the State address, he's announced that he'll be seeking to distribute $500 million between 2024 and 2025 for mental health services. Last Friday, the Wisconsin Department of Health Services underscored some of the health services that would be part of what Evers calls his "breakthrough budget."

This comes at a crucial moment. Wait times to see therapists continue to grow across all age groups — if someone can even be found. There are only three crisis centers in all of Wisconsin. Children and adolescents face unprecedented levels of anxiety, depression and suicidal thoughts.

Whether Evers will get what he wants is suspect; the Republican legislature has indicated it will throw out the two-year state budget proposal and opt to start from scratch.

Here are several key issues at play.

Medicaid expansion would help provide mental health care

Medicaid expansion is considered the linchpin of the budget proposal, at least where DHS is concerned. Wisconsin is one of only 11 states that has not expanded its Medicaid programs. According to Deb Standridge, the deputy secretary for the department, Medicaid expansion could help an estimated 89,700 additional Wisconsinites establish high-quality, affordable health care coverage, which would include mental health care.

Standridge explained that, under the Affordable Care Act, Medicaid would extend health insurance coverage to adults below the age of 65 with incomes up to 138% of the federal poverty level. A household of four making a combined income of $41,400, for example, would be eligible.

Under the current enrollment guidelines in Wisconsin, only people making income up to the federal poverty line — in this case, a family of four making a combined $30,000 — are eligible.

Evers' budget would increase hospital payments by $626 million over two years, and would also provide $250 million to increase Medicaid reimbursement rates for primary care services, autism treatment services, outpatient mental health and substance use disorder services, and child adolescent day treatment.

Medicaid expansion would allow school districts to retain 100% of federal funding received for Medicaid services, which would result in school districts getting an additional $112 million in federal funding over two years.

That's a big deal for school-based counseling efforts.

Rebecca Rockhill, executive director at Connections for Mental Wellness, a Brown County initiative that reduces barriers to mental health care, said that when mental health providers go into schools, it can be a "tremendous income drain."

Many of the providers work with children on Medicaid, where reimbursement is only partially covered under current law. School districts retain 60% of the federal funding received, with much of that going toward administrative costs.

Nothing will help without solving shortage of providers

Mitigating the mental health crisis goes beyond politics and money — even hundreds of millions of dollars of it. So much depends on whether the state can successfully attract mental health providers to work in underserved regions of the state.

Long wait lists across mental health services, shortages in child and geriatric psychiatrists, shortages in medication-assisted treatment providers and clinics, and shortages in competent translation services are but some of the key gaps in behavioral health services, according to the 2019 Behavioral Health System Gaps Report for Wisconsin.

It's an issue that, for Dan Schroeder, chair of the Wisconsin Psychology Examining Board, will require the state to do some soul-searching.

"The particular challenge that Wisconsin has is that we're a Rust Belt state, a slow job growth state and a brain-drain state," Schroeder said. "Those dynamics have led to a situation where there has been a shortage of providers."

Standridge said that Workforce Innovation Grants in Evers budget would allocate $100 million to address the state's health care workforce. If those grants hold up in the budgeting process, "No one will be shy about taking advantage of the grants coming forward," she said.

To that end, recruitment will be crucial, Standridge said. Evers has proposed $7 million split between two years to recruit, train and retain psychiatrists and behavioral health residents at a psychiatry and behavioral health residency program through the Medical College of Wisconsin.

Andy Forsaith, director of the DHS Office of Policy Initiatives and Budget, said an additional $2 million per year in the proposed budget would expand the Child Psychiatry Consultation Program, a program for primary care providers designed to improve mental health care for children and adolescents, into a broader Mental Health Consultation Program. That expansion would serve both children and adults, allowing psychiatrists, psychologists and other health professionals to do consultation.

Budget would provide more for adults in crisis, farmers, people with disabilities

When someone gets into a car crash, there's a continuum of care that extends from law enforcement officers to emergency medical technicians to hospital staff. In circumstances where someone wants to take their own life, the system of care is patchwork at best, according to DHS.

Evers has proposed investing more than $10 million over two years to develop up to two crisis urgent care and observation centers that would offer the kind of continuum of care afforded to someone experiencing a physical emergency. Included in this would be a range of behavioral health services, the option for walk-in appointments and a dedicated first responder emergency drop-off location.

Additionally, the budget would provide $1 million to maintain and continue operations at the three existing crisis centers in the state that are specifically designed for the needs of youth. Those facilities are Wisconsin Community Services for boys aged 10 to 17 in Milwaukee County, Lad Lake Masana for girls aged 13 to 17 in Milwaukee County and North Central Health Care for boys and girls 17 and under in Wausau.

Evers also wants to spend nearly $2 million toward a statewide behavioral health treatment program directly for the deaf, hard of hearing and deaf-blind communities, which would include providing linguistically relevant therapists fluent in American Sign Language as well as culturally relevant therapists.

And, at a time when farmers in rural areas are dying by suicide at higher rates than the general population, the budget would also look to fund vouchers for farmers to better access mental health treatment in person or through tele-health appointments.

Wisconsin’s 988 Suicide & Crisis Lifeline services, which launched in July 2022, received 4,000 calls in Wisconsin its first month, and by the end of the year was averaging 6,000 a month. That's about two-and-a-half times the number under the old system, which was a 10-digit number. The Wisconsin Lifeline would get a boost of $3 million over two years to expand staffing and resources, a move that is necessary to prevent being outpaced by call volume.

Natalie Eilbert covers mental health issues for USA TODAY NETWORK-Wisconsin. She welcomes story tips and feedback. You can reach her at neilbert@gannett.com or view her Twitter profile at @natalie_eilbert. If you or someone you know is dealing with suicidal thoughts, call the National Suicide Prevention Lifeline at 988 or text "Hopeline" to the National Crisis Text Line at 741-741.

This article originally appeared on Green Bay Press-Gazette: Gov. Evers' biennium budget would put $500 million in mental health