State health division redesign aimed at bolstering services

The state’s proposed reorganization of health and disability services has drawn numerous questions from lawmakers including Ways and Means Chairwoman Maggie Carlton, D-Las Vegas, who complained there were “so many moving parts.”

But Health and Human Services Director Mike Willden said the idea behind the changes isn’t as much saving money as improving services to clients such as the autistic, the disabled and those needing mental health treatment.

“I think people are making this a lot more complex than it really is, budgetarily,” he said.

Legislative money committees have not decided whether to approve the changes called for in the reorganization plan.

Willden said the plan is designed to make sure services are provided by the appropriate agency and in the best possible manner.

First, he said, Child and Family Services is seeking a simple change in how juvenile justice is budgeted. He said right now the three correctional facilities — Elko, Caliente and Summit View in Las Vegas — are budgeted separately.

“We’re asking to put them into one budget account so there is the flexibility to be able to move beds around as we need them,” Willden said.

That’s the way the Department of Corrections is currently budgeted, he said. That ensures that when inmates have to be moved between institutions, the money to care for them moves with them.

The plan is in line with current practices of keeping juveniles in prison settings as close to home as possible to keep them connected to community and family, Willden said. That will result in the Nevada Youth Training Center in Elko shutting down in the next two years.

“Judges don’t want us to send kids there primarily because of distance,” he said.

One of the biggest changes on the list, Willden said, is centralizing the process of determining eligibility for the various human-services programs offered through the state, a function now spread through several offices.

The goal, he said, is “a one-stop shop” in which people would come in off the street and workers would determine which services they need and what they are eligible for, then send them to the right places instead of making them go through several eligibility processes.

“The idea is better services for people trying to get service,” Willden said. “It’s not looking for economic efficiency budget savings. It simply makes sense for people to go to one place to get service.”

Eventually, he said, eligibility in everything from mental health to disability to Medicaid and even the Silver State Health Exchange developed to meet Affordable Care Act requirements should be handled in one place.

Another proposal would move Nevada Early Intervention Services from the Health Division to Aging and Disability Services.

“It’s a disability service,” Willden said, comparing NEIS to the autism program developed two sessions ago and placed within Aging and Disability.

That way, he said, as people age out of NEIS and move to other disability services, they won’t have to do the application process over, change providers and deal with new and different rules.

Right now, Willden said, a child is only in early intervention until age 3.

“Then they need to go somewhere else,” he said. “You should be able to pick a youngster up and plug them into the right program.”

“Most of the individuals we support are going to need support throughout their lifetime,” said Aging and Disability Services Administrator Jane Gruner.

The goal is a single contracting process for all providers so that, as clients move through the system, “they wouldn’t have to change providers,” she said.

The big change for mental health services involves integrating them with public health programs in a combined Health and Mental Health-Developmental Services division, Willden said. Richard Whitley is already acting as head of both those functions, working with Public Health Officer Tracey Green, Willden said.

The idea is to begin handling mental health the same way as public health, he said. The goal is to intervene earlier in behavioral health issues, Whitley said.

“It’s simpler with public health,” he said. ‘You can’t vaccinate someone to prevent them from becoming mentally ill, but you can identify it early. People are more compliant with their treatment if we identify the illness early.”

Doing so could significantly reduce mental health treatment costs, he said.

Clinical personnel already screen for diseases in schools, Willden said. They could take that approach and go into schools to screen for mental health issues as well, he said.

Willden emphasized that, while some of these changes are already in progress in his department — some driven by the Affordable Care Act — the proposals in the governor’s recommended budget are not the final product.

“We’ve started the integration process,” Willden said. “If they don’t approve it, we’ll undo it. Would I be happy to undo it? No, but if that’s what they decide, we’ll do it.”