Nebraska Politician Focuses on Mental Health and Aging Population in New Role

Aug. 20, 2019, 6:45 a.m. ·

Mary Ann Borgeson (center, next to Vice President Mike Pence) on a trip this year to the White House. (Courtesy Photo)

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Mary Ann Borgeson has been a Douglas County Commissioner since 1994. She's also served as the first woman chair of the Douglas County Board. In July, she was named president of the National Association of Counties (NACo) which serves more than 3,000 counties in the United States. Brandon McDermott of NET News talked with her about several topics that affect all Nebraskans and her agenda as president of NACo.

Brandon McDermott, NET News: The Medicaid Institutions for Mental Diseases or IMD, prohibits the use of federal funding for Medicaid care for most patients and mental health and substance use treatment facilities larger than 16 beds. Why is this? And how do we deal with this issue?

Many Ann Borgeson, NACo President; Douglas County Commissioner: So many, many, many years ago, when we wanted to de-institutionalize individuals that had mental illness, they pretty much just kind of pulled that number out of the air. That seemed like a good number.

Mary Ann Borgeson during a convention. (Courtesy photo)

Then again, if you wanted to collect that Medicaid reimbursement, you couldn't operate your facilities with more than 16 beds. That's what it is in a nutshell. Last year, I believe – there was legislation that allowed states to submit a waiver, we asked for that not to be the case and still be able to get reimbursed by Medicaid. I know the state of Nebraska was working, or did submit, and I'm trying to find out where we are with that.

We as the county board passed a resolution encouraging the state to submit that waiver. So again, that we would be able – any provider not just Douglas County, but any provider within Douglas County – would be able to provide those mental health services in facilities with more than 16 beds and still get Medicaid reimbursement.

McDermott: Within IMD, the term mental diseases is fairly broad. Can you tell us how it’s defined?

Borgeson: And it is. We take care of individuals that have a very small issue with their behavioral health or up to some very, very, very serious mental illness. But again, we have services within Douglas County and Region 6, actually. And we have behavioral health services that are provided within that five-county area.

McDermott: You've long worked to help people in jails to get the mental health treatments they need. Can you tell us about the national Stepping Up Initiative and what can be done in the other counties across Nebraska, to help people in jail with these issues?

Borgeson: So the National Association, again, through its membership, we've talked long and hard about the mental health and jails problem, again, from de-institutionalization, that's what occurred is the communities did not have the capacity or the services in place, when states started to shut down their mental health facilities or the regional centers. What happened is individuals were being arrested and taken to jail. I understand in terms of a law enforcement perspective why that happens, but what we have created, again, is a criminalization of mental illness, and so what we need to do is look at how to decriminalize that.

McDermott: And you've been working also to create age-friendly counties while taking care of caregivers. Can you expand on your work in this area? And what the challenges are? And where we can improve?

Borgeson: As the National Association of Counties president, you get to choose an initiative that you want to focus on for the year of your presidency. I've chosen to center my attention on the older Americans.

Mary Ann Borgeson has served in county government in Nebraska for 25 years. (Courtesy photo)

By the year 2035, most people don't realize that the 65-year-old population is going to exceed our 18-year-old population. What are we doing as counties as communities across the country, to make sure that we have age-friendly services and quality living facilities for those individuals? I can tell you that a very high percentage of individuals choose to stay in their homes versus go to a facility. How do we make neighborhoods? How do we build neighborhoods? Or how do we retrofit neighborhoods to make sure that our older population will be able to stay safely, and still have a high-quality life living in their own homes – and get the services that they need?

In doing that most folks will need a caregiver. It's not that we don't have the caregivers, but it's how do you take care of the caregiver? Because think about it, those who are doing that most likely will have a family of their own. They probably have a job. And now they're taking care of their parents, their loved one, their aunt, their uncle – or whoever it is there that's added on to their burden of responsibilities. They could potentially have real burnout and how do we take care of them to be able to continue to be a quality caregiver.

So that's what I'm focusing on. What we're saying is how can we make those age-friendly counties and working with partners like AARP and others across the country – and within our own local area – to make sure that we're paying attention when we're doing our planning projects when we're starting services, or when we're just looking at the increase in the population of the aging.