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The Face of Medicaid

Chris, a resident of a group home in Mackay, asks BW to write a letter for him to the Idaho Legislature

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It is entirely possible that no issue in the history of the Idaho Legislature will have a more direct impact on the lives of Idaho's most vulnerable citizens than an upcoming vote on how to fund the state's Medicaid system.

Chris, whose last name is being withheld to protect his identify, finds it difficult to be his own advocate. Chris is a prisoner of his days, spending them at a group home in Eastern Idaho. Chris' psychosis manifests itself in short attention spans, which keep him from reading or writing, so he asked Boise Weekly to write something for him:

Mackay, Idaho

Feb. 18, 2011

To members of the Idaho Legislature:

My name is Chris.

I really need my mental-health services. I need my medication. I really need my PSR.

You see, I have to be mentally sound in order to be around my family or friends without tripping out or hallucinating or thinking about suicide. Home is better than the street for me.

Please let me have adult mental health.

You know what I'd rather not have? I'd rather not have food.

Then Chris broke his focus. He had been choosing his words slowly and carefully while making direct eye contact. But then he slipped into deep thought.

"This is making me nervous right now," Chris said in a deep, but soft voice.

He had reason to be nervous. His counseling was already cut back in 2010 due to budget constraints. Currently, the Legislature's Joint Finance-Appropriations Committee is considering a proposal that could see Chris' services slashed further or even eliminated. BW asked to talk to the Idaho Department of Health and Welfare's Medicaid director in regards to Chris' story, but the request was denied.

"We don't want to talk in hypotheticals," said Tom Shanahan, Health and Welfare spokesman.

However, somewhere at the Statehouse someone is talking hypothetically behind closed doors. Health and Welfare was ordered to provide a detailed analysis to JFAC members detailing how a possible $22 million cut would impact existing Medicaid services, such as Chris' PSR that he desperately wants to keep.

PSR stands for psychosocial rehabilitation, which aims at improving or restoring a patient's ability to function in the community or at home. Thousands of men, women and children across Idaho require PSR services due to their developmental disabilities. One scenario put before lawmakers would be the outright elimination of PSR services for adults, saving the state approximately $11.8 million.

Chris' plight puts a spotlight on a pay-now or pay-later consequence of cutting PSR services. When Chris was recently disconnected from his PSR counseling, which costs the state approximately $200 weekly, he was put on a "mental hold" by Idaho Falls police at the Behavioral Health Center. That hospital stay resulted in a bill to Medicaid--and Idaho taxpayers--of more than $60,000.

In attempting to describe Chris' psychoses, his mother referred to an Oscar-winning film starring Russell Crowe.

"Do you remember the movie A Beautiful Mind?" she asked. "Chris' paranoia was even more elaborate than that. For quite some time he was convinced there were dead babies buried all over Idaho. He thought that the FBI wanted him to work as an undercover agent. Once, when he was in a relationship with a girl, Chris thought he was pregnant."

Chris, who is now 30, was a troubled teen, but his parents chalked it up to impetuous youth. He never got into any serious trouble until he was about 17 years old. That's when Chris piled up a stack of unpaid parking tickets. He was eventually jailed and while in the Ada County lockup he was diagnosed with a psychosis. Prosecutors decided to drop all charges.

Chris spent the next several years in and out of Idaho's State Hospital North in Orofino and State Hospital South in Blackfoot, mounting huge hospital bills. Each time he was released, things went from bad to worse. At one point, according to his mother, Chris walked into a Health and Welfare office and handed the staff a large container of body fluids, claiming it contained a cure for AIDS.

Chris has also been unlucky in love. In June 2010 he met a woman while living independently in Eastern Idaho. They married a few days later, but according to Chris' mother, as soon as Chris' Social Security check arrived, she took his money, furniture and clothes and kicked Chris to the curb. He was penniless and homeless in Rigby for months. His family lost all contact with him. Police eventually put him in an Idaho Falls Behavioral Health Center.

"I've been spending thousands of dollars in legal bills trying to get Chris divorced from that woman," said Chris' mom.

Money is hard to come by. In a cruel twist of fate, she was laid off from her job last summer by Health and Welfare after serving the department for seven years. She was one of more than 100 employees who lost their jobs in the wake of the 2010 budget cuts.

After recounting Chris' long and depressing saga, his mother cracked a small smile.

"I'm rather proud of myself," she said. "I usually cry when I talk about Chris."

But indeed she had cried a few times while telling Chris' story.

"Really?" she asked. "I guess I don't notice anymore."

Chris said he now has reason for cautious optimism. He's a resident of the Antelope Creek assisted living center in the unlikely setting of Mackay. The snowbound hamlet is part of Chris' mental health solution. He has structure, friends and an occasional job as a cook at the senior center. Most importantly, Chris receives PSR services from a man he calls "one of my best friends."

"Chris is doing rather well now," said Travis Bell, Chris' counselor. "Unfortunately we had to cut down Chris' PSR from nine hours to five because of the last round of budget cuts. And now, we're at risk of losing them all."

Chris takes a battery of daily medications to keep his psychoses in check. His short-term goals include getting to know himself better and strengthening his coping skills. His long-term goals are more like dreams.

"I dream of being normal," said Chris. "I dream of being married and being a father. I'd love to be a mentor to someone."

Chris had another letter that he asked BW to transcribe, this one to his mother, father, sister and brother in Boise.

Mackay, Idaho

Feb. 18, 2011

To my family:

I miss you. I can't wait to see you. I love you very much. Tell everyone hi for me.

Have faith that Medicaid won't be cut.

Chris paused again, took a deep breath and asked a number of rapid-fire questions.

"Why are they going to cut Medicaid?"

"They can't really do that, can they?"

"Don't they know how much that will hurt people?"

"Does that mean I can't come here anymore?"

For now, Idaho's Health and Welfare Medicaid Division doesn't want to answer Chris' "hypothetical" questions.

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