Behavioral-health providers in Pennsylvania face financial instability because of inconsistent rate increases, affecting staff recruitment and retention.

In a survey from the Pennsylvania Council of Children, Youth and Family Services, one provider stated when increases occur, 70% goes to salaries, 20% to occupancy, and 10% to insurance.

Nancy Kukovich, CEO of the nonprofit youth services provider Adelphoi, recommended improved Behavioral Health Managed Care Organizations review processes for rate increase requests, citing insufficient state oversight over the rate request process.

She said their evidence-based multisystemic therapy is in need of a master's degree-level therapist, but due to lack of funding it's been difficult to recruit for this position.

"Its general claim to fame is behavioral health, but it is intense enough that it can keep kids out of the deeper end of the system," Kukovich explained. "They don't have to go to residential. They can get this really intensive service in their home. So, it's of great value to some of the counties, but it's not an inexpensive program."

The survey found Behavioral Health Managed Care Organizations sometimes offer increases during fund surpluses or when federal funds, such as the American Rescue Plan Act, are available. But the raises have not kept pace with providers' budget needs because of market competition and years of minimal increases.

Kukovich pointed out Adelphoi works with five Behavioral Health Managed-Care Organizations and has not received a rate increase in years. She noted they request the rate increase from the organizations and before approving an increase, they typically request information from providers to determine the value of the program.

"They go through a big process of trying to figure out, do we have enough of the service already? Do we need more of it? Is it something that's really important?," Kukovich outlined. "Then we usually have to fill out a whole lot of paperwork about what our costs are, what salaries look like, etc. We submit that information. We find out whether or not we get a rate increase."

Amy Fenn, senior director of Pennsylvania community-based services for Pittsburgh-based provider Pressley Ridge, oversees a variety of programs, including in-home mental health, child welfare, juvenile justice and others. She said the inconsistent rate increases ultimately affects their ability to attract and retain quality staff.

"The main thing is always salaries, because we give merit increases every year," Fenn emphasized. "Without rate increases, we're continuing to have higher costs but we still never feel like we can pay people as much as we as we should be, paying them as much as the work is worth, because without those regular rate increases, we just can't keep up with the expenses."

The survey shows behavioral health providers are competing with school-based jobs offering better pay and hours. To stay competitive, providers have raised salaries by up to 11%, despite limited funding. It recommends linking salary increases to actual costs and exploring flexibility within Behavioral Health Managed Care Organizations.


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An Eau Claire resident is speaking out about how federal cuts to Medicaid and the Supplemental Nutrition Assistance Program could affect his life and his family's.

Oliver Winn and his parents all live with disabilities. He said Medicaid has allowed him to have surgeries that have improved his quality of life to such a degree, he no longer needs a wheelchair. It also helps him pay for medication which would otherwise cost $5,000 a month. Winn described the forthcoming federal cuts to Medicaid and SNAP as "terrifying."

"It's going to change a lot of things for a lot of people, and I'm concerned for myself, I'm concerned for my family, my community," Winn explained. "Everyone is going to be affected by this and it's a very scary time to be living through."

It's estimated more than 276,000 people in Wisconsin could lose their Medicaid coverage and another 90,000 risk losing their SNAP benefits over the next decade.

One in eight people in Wisconsin depends on SNAP to help pay for groceries. Winn is one of them. Although he currently works overnight shifts, he noted he still needs SNAP to afford food for him and his child. Before he had Medicaid and SNAP, Winn added his high medical debts meant he struggled to keep up with food and housing expenses, which led him to become homeless.

"Because there's no way to balance trying to feed yourself, trying to pay off this debt and still have access to health care and rent," Winn stressed. "It's impossible, and I wish that the people writing these bills and enacting these policies could get a taste of the life that they're creating for other people."

Along with federal cuts, the Trump administration is implementing stricter work requirements for these programs in an effort to curb what it calls "welfare dependency." More than 45% of SNAP recipients in Wisconsin are in working families and the majority of Medicaid recipients in the state are part of the workforce.

Winn argued the rhetoric suggesting beneficiaries are lazy and unmotivated is not based in reality.

"We do and want to work," Winn emphasized. "Almost everyone I know is on Medicaid. My friends, my family that are capable of working are the hardest workers I know, because we have to work so hard to scrape out ends meet."


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The mayor of Lancaster, Pennsylvania is voicing concerns about the state budget delay, warning it could affect the city's more than 58,000 residents.

Lawmakers missed the June 30 deadline for the fourth year in a row.

Danene Sorace, mayor of Lancaster, said she is closely monitoring both the state budget and the federal transportation, housing, and urban development budget coming before Congress today, noting both have significant implications for the city.

"There's been a significant reduction in federal funds that are coming to the state," Sorace pointed out. "How the state, in a divided House and Senate, reconcile these reductions in federal funding for Medicaid and address the other issues at hand, specifically equitable school funding, is yet to be determined."

Gov. Josh Shapiro said the state budget talks are making progress and expects a deal soon.

Sorace added since the "One Big Beautiful Bill Act" has passed and the state must deal with reduced federal funding, Lancaster will likely experience losses in health care access. She explained the city is fortunate to have strong hospitals and community health systems, which is not always the case in rural areas.

"I think that long term, the impacts are going to be potentially more damaging," Sorace observed. "For our rural brethren in other parts of Pennsylvania and across the country, we're more concerned about their access to health care."

The new law slashes Supplemental Nutrition Assistance Program funding by $186 billion over the next decade, adding stricter work and reporting rules, threatening benefits for many Pennsylvanians.

Sorace emphasized food insecurity was already rising before the cuts and she now expects even more demand at local food pantries.

"Our nonprofit community is trying to figure out what the state is going to do to help fill those gaps," Sorace stressed. "Of course, we're very concerned about food insecurity, especially during the summer months, when kids aren't in school and don't have breakfast and lunch always available to them."

Sorace added she recently joined more than 200 mayors at the annual meeting of the U.S. Conference of Mayors to discuss key issues, including housing and public safety. She underscored cities across the country are making progress on public safety, highlighting Lancaster's achievement of its lowest homicide rate since 1983.


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While cuts to food support programs and Medicaid gained attention as the debate over the budget bill went on, there is also a long-term likelihood it will result in automatic spending cuts to Medicare.

According to the Congressional Budget Office, the reconciliation bill is projected to add more than $3 trillion to the deficit over 10 years. If the estimate is accurate, the Statutory Pay-As-You-Go Act would require the executive branch to enact automatic spending cuts, including 4% annual cuts to Medicare starting in January, translating to around $500 billion in cuts over 10 years.

John Geer, professor of political science at Vanderbilt University and co-director of the Vanderbilt Poll, said a spring survey found Tennesseans were broadly opposed to cuts.

"We ask about Tennesseans' willingness to support cuts to Medicaid, Medicare, Social Security, veterans, etc.," Geer outlined. "And the truth of the matter is that Tennesseans are opposed to cuts in any of these programs. And it doesn't matter your partisan stripe, whether you're a liberal Democrat or a conservative MAGA-ite, you don't want to see these programs cut."

More than 1.5 million Tennesseans depend on Medicare. Congressional action would be needed to avoid automatic cuts, likely requiring a 60-vote majority in the Senate.

While funding to research under the National Institutes of Health would not be subjected to automatic cuts, the Department of Government Efficiency has already fired 2,500 researchers at the NIH and canceled more than 800 research grants. Geer's polling found more than 70% of Tennesseans oppose cutting funding for basic research.

"We asked a battery of questions about cutting research at universities, at hospitals, for drug discovery, etc., and again, there's partisan differences," Geer reported. "The MAGA folks, so to speak, are happy to do the cutting but the rest of the state has concerns."

The poll found 73% of Tennesseans support research at teaching hospitals and 66% supported research at universities.


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