The Beshear administration did the smart thing and, better yet, the right thing by agreeing to a settlement rather than risking a class-action lawsuit on behalf of Kentuckians who have mental illnesses and no place to live other than personal care homes or the street.
The settlement should greatly improve the lives of 600 individuals who will become eligible for new services, supports and housing. Also, several thousand additional people will gain greater choice in where they can live.
As welcome as this development is, no one should forget that it comes against the backdrop of a mental-health safety net in tatters. Underfunded for decades, Kentucky's mental health system is being pinched even harder now by managed care Medicaid and pension costs.
Only six states and Puerto Rico spend less than Kentucky's $53.69 per capita for mental health services. The national average is $120.56, according to the Kaiser Family Foundation.
If the promise of this new agreement is to be realized, the administration and legislature will have to help provide better community-based housing and move to rebuild the mental health system.
The good news is there will be a revenue stream that can be tapped to rebuild mental health services. For the first time, as a result of changes brought by the Affordable Care Act, Medicaid in Kentucky will pay for behavioral medicine and substance abuse treatment for the poor, elderly and disabled people covered by the federal-state program.
The bad news is this revenue stream will have to flow through the for-profit companies that manage the Medicaid program and have shown a penchant for withholding services, prescriptions and payments.
More than just improved mental health care is riding on the Beshear administration working out the Medicaid kinks and expanding access to all kinds of needed care: An additional 600,000 Kentuckians could gain access to health care next year because of the federal health care reform law, further straining a system beset by shortages of all kinds of care.
While the challenges are huge, so is the potential, and the agreement announced Aug. 16 is a move in the right direction.
In 2011, when Larry Lee of Lebanon walked away from a personal care home in Falmouth and was found dead a month later, policy makers could no longer ignore the plight of the estimated 2,300 Kentuckians who live in personal care homes. Six years earlier, Larry Bruce Huff, who had schizophrenia, froze to death after leaving his personal care home in Jenkins.
These facilities, which provide minimal services, were never intended to care for individuals who have chronic mental illness but became a dumping ground after the de-institutionalization movement failed to follow through by providing housing and programs for people who would once have lived out their years at Eastern State or other psychiatric hospitals.
The Herald-Leader reporting about deplorable conditions in some personal care homes, investigations by Kentucky Protection and Advocacy and lawmakers' concerns drove up pressure to develop alternatives.
The state plans to pay for the new services by shifting $19 million over the next three years from payments that would have gone to mental hospitals. Also, individuals will be able to use a $520 monthly supplement to pay for housing other than a personal care home.
The settlement is a step toward building a better system for people like Larry Lee, but only if there is real follow-through, which will require continued vigilance and advocacy.