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When the New York State Office of Mental Health notified mental health agencies that funding for many of their vocational and rehabilitation programs would soon be replaced with Medicaid, it seemed like good news. In addition to saving the city and state thousands of dollars, agency officials say, the switch will allow them to centralize their programs, giving their consumers easier access to more comprehensive treatment.

But, as local nonprofits begin the process of converting, some are finding just the opposite: programs and clients could suffer under Medicaid’s stricter standards.

The new program, known as PROS (Personalized Recovery Oriented Services) requires each agency to design a single treatment plan coordinated between different providers. “Our clients will get more comprehensive treatment,” said Susan Bear, division director for adult services at the Jewish Board of Family and Children’s Services, a large nonprofit that offers services such as housing, employment, and day treatment to people with mental illnesses.

But using Medicaid also brings new requirements for clients. PROS requires that clients taking part in vocational programs work at least 15 hours a week, which Shawn Moran, program director for the National Alliance for the Mentally Ill, says is too long a time. “A lot of folks are working less than that,” he said. “So what will happen to them?”

Other advocates are concerned about whether undocumented immigrants who don’t qualify for Medicaid can still be served under PROS. “Who will pay for these people?” asked City Councilmember Margarita Lopez, chair of the council’s mental health committee. In response, Roger Klingman, a spokesperson for the Office of Mental Health, simply quoted the draft regulations of PROS, which state, “All persons in need of PROS services shall be admitted regardless of ability to pay for the services.”

Although PROS will likely expand the treatment options for some clients, Moran fears that centralizing services could limit client choice, and even discourage clients from seeking help. “[Some clients] might utilize one service,” he said. With PROS, which requires greater documentation and monitoring of progress, “are consumers pressured to attend more services than they want to?”

Klingman says no. Clients “may receive PROS services from providers of their own choosing, and may receive different components of service from different providers,” he said.

But not all services are covered by PROS. Joyce Pisner, executive director at the Riverdale Mental Health Association, points out that her agency will have to look elsewhere for funding if it wants to retain job coaches, a position not funded by the new program. “The employment people play a very important role,” she said. “One of our clients was in danger of getting fired because she couldn’t get to work on time. Her job coach talked with the management,” who adjusted the client’s schedule. “That kind of intervention could make the difference between keeping the job and losing it.”

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