An Open Letter to Missouri Leaders, Stakeholders, and News Organizations RE: Proposed Cuts to the Department of Mental Health (DMH) and Impact on Medicaid & Home Health Services

To Whom It May Concern,

We are writing to bring urgent attention to the proposed policy changes that would significantly reduce funding to the Missouri Department of Mental Health (DMH), including Individualized Supported Living (ISL) programs. These proposed cuts pose a serious threat not only to healthcare providers, but to the stability of Missouri’s Medicaid system and the wellbeing of thousands of vulnerable individuals who rely on these essential services.

If enacted, these reductions will create a cascading financial and humanitarian crisis across our state.



The Real Impact of These Cuts

The consequences of reducing DMH/ISL funding extend far beyond budget adjustments and will fundamentally disrupt care systems and increase long-term costs for Missouri. The following impacts must be fully considered:



2. Increased State Costs Through Institutionalization

Individuals currently supported in community-based settings will be forced into higher-cost institutional care, such as nursing homes or state facilities. The cost of care can rise to $150,000 or more per individual annually, especially for those requiring one-on-one support, placing a significantly greater financial burden on Missouri Medicaid.



3. Workforce Instability and Caregiver Shortages

Direct care workers are already underpaid and overextended. Funding cuts will further suppress wages and eliminate positions, worsening the existing workforce shortage. This will directly impact quality of care and increase burnout, turnover, and vacancy rates across the healthcare system.



4. Strain on Missouri Medicaid System

Missouri Medicaid will face increased costs due to higher acuity placements, emergency care usage, and hospitalizations resulting from gaps in preventative and community-based services. What appears to be a short-term savings measure will result in long-term financial strain.



5. Disruption of Community-Based Care and Independence

ISL and DMH programs are designed to keep individuals in the least restrictive, most independent settings possible. Cuts will force individuals out of their homes and communities, reversing years of progress in person-centered care and independence.



6. Increased Burden on Families and Communities

Families will be left to fill critical care gaps, often without the resources, training, or support to do so. This will create emotional, physical, and financial hardship for Missouri families and caregivers.



7. Economic Ripple Effect Across Missouri

Healthcare agencies are employers, taxpayers, and contributors to local economies. Closures and downsizing will impact not only healthcare, but also local businesses, employment rates, and community stability, particularly in underserved areas.



A Call to Action

We strongly urge Missouri legislators, policymakers, and community leaders to fully evaluate the long-term consequences of these proposed cuts. The decision to reduce funding for DMH and ISL programs is not just a budgetary issue, it is a decision that will affect lives, families, and the financial future of our state.

We also call upon news organizations and media outlets to bring awareness to this issue. The public deserves to understand how these changes will impact healthcare access, economic stability, and vulnerable populations across Missouri.

Missouri has long supported community-based care as a cost-effective, compassionate approach to serving individuals with mental health and developmental needs. We must not reverse course now.

In Closing

These proposed cuts will not save money, they will shift costs, increase financial burden, and dismantle critical care systems. We urge immediate reconsideration and open dialogue with providers, advocates, and the communities most affected.



The time to act is now.