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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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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As the U.S. Senate has approved President Donald Trump's tax cut and spending bill, health care advocates are hoping to get California's Republican members of Congress on board to reject huge potential cuts to Medicaid, known as Medi-Cal in the Golden State.

The House approved the massive budget bill once before but now must reconsider the changes made in the Senate.

Matthew Herdman, California state director for the nonprofit Protect Our Care, hopes three California House members in particular will "flip" their votes.

"We believe that it's possible to stop this," Herdman explained. "When it initially came through the House, it only passed by one single vote, which means any one -- of David Valadao, Young Kim or Ken Calvert -- could vote against this in order to stop it."

The Congressional Budget Office estimated the Senate version of the bill would slash about $1 trillion from Medicaid and other health programs and it is forecast to cause almost 12 million people to lose health coverage by increasing work requirements and requiring people to verify their eligibility more often. Backers said the savings are necessary to partially cover the cost of extending Trump's 2017 tax cuts.

Rep. David Min, D-Calif., who represents parts of Orange County, said the bill would still increase the national debt by trillions of dollars.

"It's all because of this completely evil and immoral agenda to give more money to people in the world who don't need it," Min asserted. "This is so wrong, and we need to fight back."

Naida Tushnet, a member of the Long Beach Gray Panthers, said she is worried about low-income older people who rely on both Medicaid and Medicare, particularly for long-term care.

"If they have to keep filing, even if they're capable of doing it all, they're going to fall into the cracks, because the system -- that's all online -- has been stripped of humans, because they fired all those other people who could take it on the phone and talk them through it," Tushnet outlined.

President Trump has set a deadline of July 4 for final passage of the bill, so the Republican leadership in the House is furiously negotiating and will try to hold a vote in the next few days.


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An Illinois professor cautions against premature celebrations of victory or defeat after the U.S. Senate passed President Donald Trump's budget reconciliation bill Tuesday.

The Senate narrowly passed an amended version of the bill after Vice President JD Vance's vote broke the 50-50 deadlock. The bill now goes back to the House because of the changes made to it in the Senate.

Brian Gaines, professor of political science at the University of Illinois, said the narrow margin in both chambers still makes the bill's future uncertain.

"We've seen the House being pretty unruly lately and it's a very small margin for the Republican majority, so I think there's a lot of suspense about what the House is going to do next," Gaines explained. "This is not yet the time for a victory lap for Donald Trump or the '(One) Big Beautiful Bill (Act).'"

Gaines noted Rep. Mike Johnson, R-La., the Speaker of the House, has already faced difficulties in uniting the Republican Party on key issues like Medicaid, Social Security and local and state taxes. He added the changes made in the Senate to address the issues could further complicate its fate in the House.

The House will now work to pass the bill by Friday. Gaines views the President's July 4 deadline as potentially flexible, yet strategically important, since most folks in Congress would like to go home for the holiday weekend.

"The danger, of course, of people going back home is that they're more likely to hear opposition than support," Gaines observed. "You might end up with a caucus that's even harder to get on board after they've had the chance to hang around barbecues and have people complain to them."

Gaines emphasized the difficulty of passing legislation with small majorities and praised Johnson's skill in navigating the challenges. He noted the unpredictable nature of large legislative outcomes and the uncertainty about exactly what's in the massive bill make it hard to hone in on any implications.

"Surprisingly often, when there's a very big bill like this, 'We have to pass it to know what's in it,' turns out to be true in some respects," Gaines added. "Some of the consequences you see months later are not the ones that we were talking about in advance."