Nothing was spared from state budget cuts during the Great Recession and its aftermath, but behavorial health and addiction treatment centers felt the cuts particularly hard as demand for their services skyrocketed with increased use of heroin and other drugs.
Even now, as the economy appears to be making a comeback, most bills in the Florida Legislature calling for increased funding failed during the most recent sessions.
"There's not an appreciation for the strain on the system," said Mary Ruiz, president and CEO of Manatee Glens, who works with state lawmakers every session on behavorial health and addiction funding and regulations.
"Every year, I have to decide what program I'm going to cut."
Since 2009, Manatee Glens has had to close 16 beds in the teen residential drug treatment program, 20 beds in adult residential mental health treatment, 15 slots in outpatient detoxification and 22 slots in children's day treatment. About 10.5 percent has been cut from their
state and local government funding since 2008.
The pill mill epidemic was still in full swing in 2009, when people would get prescription painkillers from doctors that they didn't really need and sell them cheaply on the streets. After the pills mills were shut down in 2011, heroin use began to skyrocket, resulting in eight people dying in 2012, to 19 in 2013, to 63 in 2014, to 54 through mid-May in 2015, without significant increases in treatment funding.
Florida sits at 49th out of 50 states in mental health services funding, according to fiscal year 2012 figures from the Kaiser Family Foundation, which includes addiction treatment funding. The U.S. average for per capita spending in millions on mental health services is $129.99, and Florida's per capita spending is $37.28, only higher than Idaho.
Figures were available for every state except Florida and New Mexico in fiscal year 2013, but if Florida's remained at $37.28 it would be 49th in that year as well, when the U.S. average dropped to $119.62 per capita.
Several pieces of legislation in the last Florida legislative session looked to increase funds to the behavorial health and addiction treatment industry. But no bills made it through, and funding increases to Manatee Glens amounted to $300,000 for a residency program in psychiatry for their mental health departments, not specifically for addiction.
"That's not going to fix this problem either, but it adds more professionals to the team at Manatee Glens," said Rep. Jim Boyd, R-Bradenton. He later added that though it doesn't seem like much, he believed an additional six residency positions to the area would greatly help.
The Legislature just ended a special session on the state budget, which had to be called largely due to controversy over Medicaid expansion and Low Income Pool funding. The Senate put both Medicaid expansion and healthcare funds for low-income populations, or LIP funding, in its budget, while the House put in neither. Ultimately, all Medicaid expansion possibilities were nixed, the LIP fund was depleted by the federal government and lawmakers used $400 million in state surplus money to try to patch the wound.
Ruiz said while Medicaid expansion wouldn't have solved everything for them, it definitely would have had a positive impact.
"We serve about 16,000 people per year, and 500 of those people would be insured under Medicaid expansion. That takes them off indigent funding and puts them on insured," Ruiz said. "It's a good thing for us, but it's also not a panacea."
Lawmakers considered a few bills on funding, but one that got close, Senate Bill 7068, became a casualty of the Medicaid expansion controversy during regular session and most funding opportunities were not reintroduced in the special session.
SB 7068 would have increased funding to behavioral healthcare providers through federal Medicaid dollars and possibly through state matching funds. It would have initiated revenue maximizing opportunities, such as easing licensing requirements, which Ruiz said would be cost effective though not a huge money saver.
Ultimately, the House and Senate agreed to continue relying on federal LIP money and putting state surplus money into the depleted LIP fund instead of Medicaid expansion.
"My fear is, because of the LIP impact, and where we end up negotiating, that it's still going to be a tight year for a lot of these (behavioral health) programs," said Senate Majority Leader Bill Galvano, R-Bradenton, prior to the special session.
Boyd, vice majority leader of the Florida House, said prior to the special session that they would try to use the funds available to help institutions such as Manatee Glens, but that there were a lot of different priorities to cover in the state budget.
"There's a finite pot of resources. ... Unfortunately, there's only so much that we can allocate to different areas," Boyd said. "Little by little, step by step, we're trying to tackle those and fund them as we can."
Both Boyd and Galvano said the climate in Tallahassee was the best they've ever seen it for addressing the behavioral health issues, yet increases to behavioral health funding over the special session were minimal. That especially came under scrutiny considering private companies such as IMG Academy, a Bradenton for-profit sports academy, received $2 million in the budget last minute. Gov. Rick Scott has not yet signed the budget, and therefore can still veto budget items.
"There are economic incentives that add jobs to our community," Boyd said in defense of giving public money to the for-profit facility. "That ultimately will add tax base funding to the budget, which gives more money to fund other items."
Galvano said he was part of a group in 2008, when he served in the House, that tried to address mental health funding, but that there wasn't enough support to get legislation passed. This year, he said there was support, citing the Senate's passage of SB 7068. Boyd said though the bill failed in the House, he still counts behavioral health funding as one of the higher priorities.
Despite such reiterations that mental health care needed attention, both Galvano and Boyd cited the problem of a limited pot of money and a large amount of priorities. And ultimately, increases to behavioral healthcare state funding in 2015 were minimal.
Galvano, Boyd and Ruiz said they knew the state wouldn't be able to cover all the needs of institutions like Manatee Glens. Lawmakers are aware of the strain, and they're aware that treatment needs more funding. But at the end of the day the money went elsewhere.
Ruiz estimated that they would need 20 more publicly funded detoxification and residential treatment beds to adequately meet the need in the Manatee County area.
That's more than double the 14 currently publicly funded beds. But she said she knows better than to expect adequate funding from any government entity for that many additional beds.
"You know, it's sad," she said. "I never made that projection before, because it would be a waste of time."
Kate Irby, Herald online/political reporter, can be reached at 941-745-7055 or at firstname.lastname@example.org. You can follow her on Twitter @KateIrby