Changes Underway for Wyoming’s Behavioral Health System

July 2, 2024

After several years of planning and coordination with partners across the state, changes to Wyoming’s behavioral health system are underway, according to the Wyoming Department of Health (WDH).

“For many years, our department has paid millions of state dollars to community mental health centers to help ensure access for Wyoming residents who sought care for mental health and substance use related issues regardless of their ability to pay,” said Stefan Johansson, WDH director. “It’s one of our largest budget items and is clearly important, but there have been challenges.”

A significant new law passed in 2021 by the Wyoming Legislature supported efforts to strengthen Wyoming’s behavioral health system. A chief goal is focusing state resources on those who need them most: acute psychiatric adults, criminal justice involved clients, high needs children and families and low income and indigent general access populations.

Johansson said, “We really want to help ensure high-needs people facing serious mental illness do not fall through the cracks before their needs grow. As we have carefully prepared for these changes, a focus for our department and our partners has been to help answer the question of ‘What is state government’s role?’”

To help direct the state dollars toward where and when they are needed most, the redesigned process is meant to help ensure people seeking services who could qualify for financial help from other sources such as Wyoming Medicaid or private insurance are supported through those sources rather than through state funding alone.

“When Wyoming’s community mental health system was designed, there was less financial support available for behavioral health services through options such as private insurance. But that has since changed, which presents an opportunity to potentially share the financial load,” Johansson said.

Franz Fuchs, senior policy analyst with WDH, said “One thing people will notice is all residents seeking state-paid behavioral health services must now submit an application through Wyoming Medicaid. While this does not mean you have to be eligible for Medicaid to be helped, this step will check for other potential pay sources beyond state general funds and verify income, citizenship and residency.”

Without an application on file, WDH will not be able to pay for services received after July 1. “The community health centers and organizations such as Enroll Wyoming can help people complete the needed application,” Fuchs said.

Because Wyoming Medicaid is also part of WDH, using existing systems to check eligibility and to manage payments to the community mental health centers is an efficient solution.

Fuchs acknowledged some individuals will no longer be eligible for state-supported services from the community mental health center network. These include people with incomes over 200 percent of the Federal Poverty Level (FPL) who do not have significant behavioral health needs. For those in this group who do not already have insurance, heavily subsidized insurance is likely available through the federal marketplace.

There are also changes to provider payments. “We’re moving from block grants to a mix of block grants, service payments and outcome payments,” Fuchs said.

“The hope for many involved in this redesign effort is that focusing the state’s resources on high-needs clients may eventually lead to cost-savings and reduced pressure on other elements of Wyoming’s behavioral health system such as frustrating waiting lists,” Fuchs said. “If we can reduce repeated hospitalizations or divert people from institutional settings in the first place, that’s a win for both clients and for our state facilities.”

Matt Petry, Behavioral Health Division senior administrator with WDH, said, “We are making big changes and we certainly recognize that change isn’t always easy. We are truly grateful and want to thank our partners in Wyoming’s community mental health centers, law enforcement personnel, leaders in local and state correctional facilities, judicial system representatives, Department of Family Services staff and the state’s policymakers for their participation and willingness to work with us.”

A San Francisco bookstore is fighting back against escalating anti-LGBTQ+ book bans across the US by sending prohibited queer texts to communities battling censorship.

Fabulosa Books, located in the Castro, the city’s historic gay neighborhood, has received widespread support during Pride month for its Books Not Bans program, which allows customers to buy and send books to LGBTQ+ organizations operating in conservative parts of the country.

Becka Robbins, founder and director of the program, and the bookstore’s events manager, launched the initiative last year, inspired by repeatedly witnessing how impactful it can be when youth discover queer literature for the first time: “At the store, I’ve seen young people who don’t have access to these books, and it’s definitely a cinematic moment, where they are like: ‘Oh my god!’ … This should be ordinary. They should see this queer lit in their own libraries, in their classrooms, on their parents’ bookshelves. But they’re not.”

She decided the most practical way to push back against bans, which have become a priority of anti-LGBTQ+ school boards across the country, was to send books directly to groups that could provide them to readers who might not be able to access the texts in their schools or through their families.

The project is a grassroots effort that operates out of a closet in Fabulosa, and since launching, Robbins said she has sent more than 700 books to states across the US, including Texas, Florida, Alabama, Arkansas and Oklahoma.

“I really believe in the power of fiction as a driving force for connection, resilience and empathy. It gives you the capacity, in a way that nothing else does, to connect with people who are different than you,” Robbins said. “There’s been times in my life where fiction has really kept me going.”

She has more boxes ready to ship, and since the program got recent news coverage in the Los Angeles Times, the Associated Press and local television stations, donations have been pouring in, with more people stopping by the store wanting to buy books for other communities: “It’s been a community effort. Customers come in and pay for entire boxes and say: ‘Send this to Florida.’ They leave a note that says: ‘Hang in there, you’re going to get out of that place.’ It’s encouraging and also a little heartbreaking. People shouldn’t have to leave to find safety and comfort.”

The American Library Association (ALA) reported in March that more books were banned in 2023 in US schools and libraries than any other year on record – 4,240 titles censored, which was more than the previous two years combined. Many targeted books are about race and LGBTQ+ people.

Last week, South Carolina adopted one of the harshest book ban laws in the country, with a vague policy requiring books to be “age or developmentally appropriate”, an edict that could impact a broad range of texts. Public school textbooks have also increasingly been targeted, with literature on the climate crisis, vaccines, history, racism and sex education facing censorship.

Fabulosa owner Alvin Orloff said some of the local patrons supporting Books Not Bans come from the communities that are now facing rising censorship: “Our customers live in San Francisco, but they know what it’s like to grow up in a small town where everybody’s bigoted. So they feel really strongly that they want to do anything they can to make life easier for the next generation.”

The program is also designed to show solidarity with transgender and queer groups that are sometimes faced with significant backlash and violent threats over their efforts to defend people’s rights, Orloff added: “There’s a psychological thing for them to just know there’s people out there who are thinking about them and care about them, that they’re not invisible, that there’s a world beyond their community that values them.”

Watching the escalating book bans has reminded Orloff of the 1970s campaigns of anti-gay activist Anita Bryant, who claimed her efforts were about “saving the children” and promoting parents’ rights: “Politicians just want to whip up the fear. It’s a big, symbolic thing for them to say we’re ‘protecting the children’. It’s the same thing they were saying 50 years ago when I was growing up.”

“Books offer a wider variety of role models and a greater understanding of queer communities than you’re going to see in the movies,” Orloff added. “It just makes you feel so much better to know that there are people like you out there and that you don’t have to have a life constricted by people who don’t value you.”