State considers phone fee, other sources for 988 services

Nearly every stakeholder agrees that Indiana needs to improve its mental health supports—as demonstrated by the emotional testimony last week for Senate Bill 1, which seeks to shore up ongoing initiatives and formalize the 988 crisis response system.

But the most important detail–how much funding the state will provide–has yet to be determined.

Many aspects of the state’s two-year budget are still moving, especially when it comes to health initiatives. Potential funding streams for health priorities could come in the form of a tax on alcohol or cigarettes–the latter of which anti-cancer advocates have sought for years.

But the federal act establishing the 988 hotline, designed to operate similar to 911 but for mental health rather than public safety, allowed states to implement a different sort of tax: a monthly fee tacked onto resident phone bills.

“For me, I’m most concerned about having a predictable funding stream as we ask folks to expand their capacity. This isn’t going to be every two years where somebody like me is here fighting for (their) budget,” Sen. Mike Crider, R-Greenfield said.

Crider, the author of Senate Bill 1, is also a member of the powerful Appropriations Committee that will publicize its own version of the budget this week. Discussions about the phone tax and how much to charge are ongoing, he said last week.

Funding 988 for mental health emergencies

Calls to 988, which launched nationwide in July as the new number for the National Suicide Prevention Lifeline, have skyrocketed, jumping from 161,678 to 404,194 between February 2022 and February 2023. Texts to the line have increased by 700%.

The federal government made the initial investment, but states will be responsible for funding the local call centers, and a handful have already implemented their phone tax, which ranges from $0.40 in Washington and $0.12 in Virginia monthly.

Nearly two dozen other states have pending legislation to implement their own fees or add budget line items, but few have finalized their revenue stream.

Charging a monthly phone fee has a precedence. Hoosiers see a $1 fee with every phone bill to fund 911 call centers. A fall report called for duplicating that $1 charge for 988 but that charge would make it the highest in the United States.

That $1 would produce roughly $90 million annually, just over two-thirds of the estimated $130.6  million needed to cover the entire 988 system.

But Crider said that $1 fee might be a hard sell.

“The difficulty is when the state has a surplus, a lot of folks do not like the idea of a new fee of any kind,” Crider said.

State revenue continues to come in slightly above projections, bolstering a surplus that grew so large during the COVID-19 pandemic that it triggered an automatic taxpayer refund and prompted lawmakers to send eligible Hoosiers a second check.

Crider, a former law enforcement officer, said the $1 charge for 988 would just be equivalent to the charge for 911 and saw them as both important.

“From my perspective, that’s just kind of part of the discussion because we already use the $1 fee to find our 911 systems,” Crider said. “It’s an interesting position to be in because the state does have a surplus currently and the reality is that everybody else is in the room asking for some of that money.”

Ongoing funding concerns for 988

Despite the current uncertainty around 988 funding, Indiana actually had one of the best in-state answering rates for residents, at 93% in December of 2022, the first of three pillars for the proposed mental health overhaul.

As Crider noted, the 988 system is expected to expand in the future, especially as the state develops a more robust system of community-based providers. These agencies will be responsible for the other two key aspects of behavioral health reform: someone to respond to calls and a place to go.

Limited mobile crisis units have started in some areas of the state and some have beds for more intensive crisis stabilization treatments, like 4C Health which has various services in seven counties of north central Indiana.

Carrie Cadwell, the CEO of 4C Health, testified on Crider’s bill last week, detailing how her organization is working to include more comprehensive mental health services.

Agencies like hers are shifting from Community Mental Health Centers to Certified Community Behavioral Health Clinics, a prohibitively expensive process that will need to be replicated across the state.

But the need is evident, especially as mental health disorders increased during the COVID-19 pandemic. To Crider, that demonstrates how important it is for funding to be secured.

“The timing of this is critical; I don’t want to see a decrease in access to care,” Crider said.

The Senate version of the budget is expected to be released this week and will be updated the following week after the release of the next two-year revenue forecast.