WITH THREE state-funded youth mental health programs at risk of closing, lawmakers and providers ramped up their opposition this week to Gov. Maura Healey’s proposed budget cuts that come as Massachusetts continues to grapple with a behavioral health care crisis.

Two 15-bed intensive residential treatment programs (IRTP), operated by NFI Massachusetts in Westborough, that serve teenagers with serious mental health and safety issues would close under Healey’s fiscal 2026 spending plan. That would leave just two other IRTPs in the state.

The governor’s budget would also shutter the state’s only clinically intensive residential treatment (CIRT) program, called Three Rivers in Belchertown, that has a dozen beds and treats children ages 6 to 12.

At a budget hearing Monday in Attleboro, Department of Mental Health Commissioner Brooke Doyle said those facilities are slated to close due to low patient counts, inadequate staffing and location hurdles. The cost-saving measure comes as DMH — which would receive a 7 percent overall budget increase under Healey’s proposal — looks to prioritize resources for its over-capacity psychiatric hospitals.

“These programs have been very difficult to maintain adequate and safe staffing within. They’ve been understaffed for extended periods of time, and that has contributed in large part to why we had difficulty keeping all the beds filled,” Doyle said in Attleboro. “The programs do provide a specialized service need, and the reality is, that we haven’t been able to operate them fully today. So what we’re proposing to do is to right-size the IRTP, reflecting the volume that does get utilized.”

Doyle said the state pays for those beds “in full,” regardless of whether or not they are occupied. She argued that makes it “not sustainable to continue to pay for 50 percent utilization.”

Doyle highlighted the state’s investment in community-based mental health resources, though the IRTP and CIRT programs are seen as a last resort to stabilize young patients who repeatedly end up in the hospital and pose significant safety risks to themselves and their family.

“Without these services, youth will continue to cycle through expensive and disruptive emergency and acute hospital services,” Lydia Todd, executive director of NFI Massachusetts, said at a State House budget hearing Tuesday, according to a copy of her prepared remarks. “Their families face income loss because it is impossible to maintain employment when they are regularly needed to respond to mental health crises.”

Todd added, “If this program is closed, the commonwealth will lose a recently renovated facility, a highly credentialed, experienced and skilled multi-disciplinary team of 95 staff, a Joint Commission-accredited program, and most importantly, the ability to help youth and families with the most serious needs to manage their mental health issues in their natural communities, and be less likely to end up in one of our adult systems.”

Todd told the News Service 95 out of 100 positions are filled. 

“We could be fully utilized — no problem,” she said. 

Program leaders and lawmakers contend the programs are underutilized due to a complicated DMH referral process that can leave youth languishing in hospitals for weeks or months before they secure placement. Due to high staff turnover during the COVID pandemic, some hospital mental health providers also were unaware the IRTP and CIRT programs existed, said Sen. Jake Oliveira of Ludlow. 

“It’s my hope that we can restore the funding for these critical programs because everything that we hear from constituents and everything that we read, there is a dire need for youth beds, particularly adolescent mental health beds throughout Massachusetts,” Oliveira told the News Service. “If we have programs that are underutilized, then DMH needs to do a better job with the referral process to get help to families across Massachusetts.”

Doyle admitted the referral process was “too clunky” at the hearing Monday.

“So I’ve actually made some changes to that referral process, going to preview it with stakeholders this month, with a go-live plan for May,” Doyle said.

In another major budget cut, DMH plans to slash the case management workforce in half, which would save the state $12.4 million. That move recently triggered DMH workers represented by SEIU Local 509 to take a vote of no confidence in Doyle. 

Gov. Maura Healey has already hit pause on a controversial plan to shutter a 16-bed psychiatric hospital in Cape Cod. That closure, combined with the three youth mental health programs, would have saved the state a total of $20.1 million, according to a presentation from the Executive Office of Health and Human Services.

As House Democrats prepare to release their budget next week, Rep. Aaron Saunders of Belchertown said he plans to fight to ensure the CIRT, operated by Cutchins Programs for Children & Families, receives funding.

“We need it to be there,” Saunders told the News Service. “It is a level of intervention and service that other programs are not designed to provide, and that to me really is the linchpin.”

Saunders added, “In my conversations with the administration, I’ve tried to impress upon them that there needs to be access, in some way, shape or form, to this level of service.”

Tina Champagne, CEO of Cutchins Programs for Children & Families, urged lawmakers Tuesday to “dig deeper and to save our programs.” In prepared remarks, Champagne said the state remains in the throes of a “children’s mental health crisis” and argued “this is no time for a reduction in intensive mental health services in our state.”

“The decision to cut the CIRT is not only in direct opposition to well-established evidence-based practices for children and families with some of the most persistent and challenging mental health and safety concerns, but also puts the the most vulnerable children and families in the commonwealth at even greater risk by perpetuating the cycle of ACES and traumatic experiences,” Champagne said, referring to adverse childhood experiences.

She added, “The degree of safety and mental health challenges that must occur for youth to be considered for a DMH referral for the CIRT is highly intensive and the youth’s safety concerns are typically quite serious. If these youth could be treated elsewhere in the community, they would have been referred to those services, and usually have already utilized these services, but they are not intensive enough to maintain safety and mental health stabilization.”

At the hearing, Oliveira told Doyle he was insulted by her remarks that signaled the Belchertown program was not viable due to its location in western Massachusetts.

“That’s insulting to any western Mass. lawmaker who might be sending people halfway across the state, hours away to get the programs to utilize them,” Oliveira said.

The commissioner told Oliveira she regretted if her testimony seemed to be “disrespectful.”

“It’s more of a matter that we have to weigh parents’ requests and parents’ priorities, as well,” Doyle said. “So, it has always been a western Mass.-located program. It’s not new. And what we’re seeing is that it is getting a bit more challenging, particularly with workforce constraints, that when we don’t have full staff operating, it requires that the department have to make decisions with parents about whether or not their their child can be safely treated in that environment, based on staff that are available at that time.”

Rep. Kelly Pease, a Westfield Republican, questioned whether the adolescent mental health programs represented the “smart place” for DMH to make cuts. Without providing sufficient care to young Bay Staters early on, the state may exacerbate the prison pipeline and end up incurring more costs in the future, Pease told Health and Human Services Secretary Kate Walsh.

Walsh insisted those programs were 50 percent occupied and emphasized EOHHS’s push to “right-size our behavioral health infrastructure.” Pease argued the low patient census was a function of DMH’s “antiquated process to get a referral.”

“I think the question for the Legislature is: Do you want to pay for standby capacity in two or three programs across the state that may or may not be used?” Walsh said at the hearing Monday. “In the meantime, you should challenge us to significantly improve our antiquated or very complicated processes to get people into these systems — some of which, I will remind us, were the result of court decisions. So we have patient referral pathways for people with, for children with behavioral health challenges that were built by lawyers, with due respect.”

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LAST SESSION, Beacon Hill’s big three – the governor, the House speaker, and the Senate president — each had fundamentally different ideas about how to reform the state’s health care system, and attempts at compromise sputtered and failed.

Now, Gov. Charlie Baker is taking another go at changing the health care marketplace, and he’s getting some early buy-in from House Speaker Robert DeLeo and Senate President Karen Spilka, which may have something to do with the fact that the governor’s sweeping health care proposal borrows extensively from provisions that have passed either the House or Senate but stopped short of becoming law.

After a closed-door meeting with top lawmakers from the House and Senate on Monday, there was some good-natured ribbing between DeLeo and Baker about the scale of the project.

“I think there’s going to be a long-term process,” DeLeo said. “I mean, obviously, it’s a lengthy bill that the governor has provided.”

“It’s only a hundred pages long,” Baker interjected.

“I think it’s more like a novel,” DeLeo countered, in stride.

The jocularity appears to signal more camaraderie on health care this time around.

DeLeo went on to say he appreciated how the governor had incorporated some of the ideas that the House has previously advanced, and he thinks “it’s the beginning of what’s going to be a long and, hopefully, I feel a productive discussion, but I think it’s a good start.”

That would be a departure from last session when the governor’s cost-saving proposal for MassHealth was swiftly rejected by lawmakers who then failed to agree on their own health care legislation before the end of the session.

In his filing letter, the governor focused on how his bill attempts to shift the system’s emphasis from technological advancements to hands-on care, but other provisions in the 160-section, 179-page bill would alter other key aspects of health care, especially on the issue of pharmaceutical pricing.

The annual state budget that was signed into law authorizes MassHealth to negotiate prices with pharmaceutical companies, and it includes some accountability measures intended to encourage fairer pricing by drug manufacturers. The governor’s proposal extends similar accountability measures to the commercial insurance marketplace, according to Health and Human Services Secretary Marylou Sudders, who said it would also create some regulatory oversight on pharmacy benefits managers, who act as brokers between the drug-makers and insurers. Additionally, the bill would require the pharmaceutical industry to participate in the annual discussion of health care cost trends convened by the Health Policy Commission, and it would require pharmacists to disclose the cheapest option to customers, Sudders said.

The Massachusetts Biotechnology Council, which represents the pharmaceutical industry, swiftly condemned the governor’s approach, casting blame on the insurance industry for rising costs.

“The administration’s proposal misses the mark by not including any proposals that would directly control skyrocketing health insurance premiums and patient out-of-pocket costs,” said MassBio President Bob Coughlin in a statement.

The big ticket item in the governor’s bill does not directly address the issue of costs to consumers, but Sudders said she thinks that in the long-run it would make the system run more efficiently. Baker proposes requiring providers and insurers, including MassHealth, the state’s Medicaid program, to increase spending on behavioral health and primary care by 30 percent over the course of three years.

That increase in spending on primary care and behavioral health should occur within the existing goals for limiting the growth in overall health care costs, according to Sudders and others, who said it would shift the priorities for the big players in the marketplace.

The medical industry’s success at treating chronic illness with innovative therapies has overshadowed the more labor-intensive work of caring for people with chronic illnesses and addiction issues, Baker wrote in his filing letter.

The required increase in spending would result in easier access to primary care and behavioral health interventions, which over time should bring costs down by relieving emergency departments from the burden of handling behavioral health crises, Sudders said.

That approach struck a positive chord with Spilka, who has a degree in social work and has been employed as a social worker.

“I’m excited about looking at some of the behavioral health aspects of it, and increasing parity in behavioral health,” said Spilka.

Senate Ways and Means Chairman Michael Rodrigues was even more enthusiastic about the governor’s bill, although he deferred to Sen. Cindy Friedman, the co-chairwoman of the Committee on Health Care Financing, on the specifics.

“I like most of it,” Rodrigues said. “The bill addresses a lot of the areas that we’ve addressed in the past.”

House Ways and Means Chairman Aaron Michlewitz was more circumspect, indicating that he and others appreciated the inclusion of provisions that the Legislature advanced last session but he would need more time to review it.

Massachusetts Association of Health Plans President Lora Pellegrini had only positive things to say about the bill, saying it “targets areas that drive up medical spending, including important provisions to address the rising cost of prescription drugs and increased transparency to better understand how pharmaceutical manufacturers set drug prices.

“The Governor’s bill also reins in the ongoing practice of surprise billing, establishes clear standards for urgent care centers, and puts an end to unfair facility fees. These practices cost consumers and employers millions of dollars in additional spending each year,” Pellegrini said.

Steve Walsh, the president of the Massachusetts Health and Hospital Association who helped draft the big overhaul to the health care system in 2012, called the bill a “tremendous opportunity” to adapt to the needs of the changing population, which Baker said is increasingly beset by chronic disease.

The debate in Massachusetts occurs in the shadow of a more brash national debate over the future of health care that has split the Democrats running for president between those who want government to supplant the role of health insurers and their more centrist rivals who argue in favor of smaller changes that build upon the existing structure of Obamacare.

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