The crises hit Michelle Wood's family around the same time: Her teenage daughter's mental health worsened, and her husband was diagnosed with stage four pancreatic cancer.

But the health care system's response to the situations has been "the polar opposite," she said.

"With his cancer, he's got the oncologist; they have got palliative care; they immediately got me hooked up with a caregiver group. ... They try to surround you with services and support you to get you off on a good foot," Wood said.

But for mental health, "there isn't any of that."

Hundreds of kids and adults across Minnesota can't access timely mental health services and are stuck in hospitals, juvenile detention centers and jails. Others remain at home with loved ones who fear they will hurt themselves or others.

Families, social workers and advocates have said for years that the state's lack of mental health services hurts Minnesotans who need the most help. Now, they say plans at the Capitol could be "transformational" in preventing provider closures and expanding programs.

Legislators have a couple weeks to finish work on a state budget for the next two years. Their spending proposals contain changes that could help tackle what is often referred to as the "boarding" problem, where people spend weeks or months — and sometimes more than a year — in hospitals or corrections facilities, waiting for a mental health facility willing and able to take them.

For those immersed in that crisis, one idea stands out: raising reimbursement rates. Providers say the payments they get through Medical Assistance, Minnesota's Medicaid program, fall short of the cost to do the work and they can't pay enough to attract and keep workers.

"It's critical to fund these programs if we want to be proactive and help get kids and families the supports they need and the mental health care they deserve," said Stephen DeLong, the lead mental health social worker at Children's Minnesota's emergency department.

He said more than 77% of the children boarding at Children's Minnesota hospital have Medical Assistance.

Paying for the rate fix

Medical Assistance reimbursements are roughly 30 cents on the dollar compared with commercial payments and 70 cents on the dollar compared with Medicare, said Dave Renner, director of advocacy at the Minnesota Medical Association.

"It's not just about our doctors or our psychologists getting paid enough — it's can they afford to keep their doors open?" he said.

A state study last year recommended changes, including raising the outpatient rates for some services to 100% of what Medicare pays. That idea is part of a Senate budget bill this year.

There has been bipartisan support for raising the rates, Renner said, but enthusiasm wanes with the question: "Well, how do you pay for it?"

A Senate health and human services measure would add an assessment on managed care organizations, such as UCare or HealthPartners. The organizations would pay the state roughly $900 million over the next two years, according to a legislative budget document.

But Renner said they would get back 99% of the money. Federal funds would cover 60% of the repayment and the state would be on the hook for the other 40%, he said, noting the approach is based on what other states have done.

The Minnesota Council of Health Plans, an association of nonprofit health insurers, is sympathetic to the too-low Medical Assistance rates, especially for mental and behavioral health services, President and CEO Lucas Nesse said. But he said the potential funding plan would make commercial health insurance more expensive.

"We would love to see increases in state Medicaid rates that don't result in increases in commercial costs," Nesse said. Association members would rather see the state use existing funds to leverage federal dollars, he said.

Sen. Melissa Wiklund, DFL-Bloomington, who sponsored the bill and leads the Health and Human Services Committee, said the legislation contains another proposal that hospitals put forward to assess themselves, rather than managed care organizations.

But Minnesota Hospital Association officials said that proposal isn't specifically focused on mental health.

Wiklund said she's hopeful lawmaker can agree on some version with the House, which is evenly split between Democrats and Republicans, and was still negotiating a health bill last week.

"The Wiklund plan would raise taxes, while we'd prefer an approach of redirecting existing spending towards priority areas like mental health care access, EMS support, nursing homes, etc.," House GOP spokesman David Anderson said in an email.

The House bill would use state general fund dollars to gradually increase rates for services, Rep. Robert Bierman, DFL-Apple Valley, co-chair of the Health Finance and Policy Committee, said Wednesday. But he said he likes the Senate's version because it would establish ongoing funding and allow Minnesota "to do more faster."

More plans to tackle crisis

Dozens of adults, some languishing in jail, were on a waitlist last year for the state's largest psychiatric hospital. Advocates hope lawmakers will devote funding in an infrastructure borrowing bill to add 50 beds at the Anoka-Metro Regional Treatment Center, which a Department of Human Services spokesman said currently has 96 beds.

Budget bills also contain measures advocates say could keep people from needing more intensive help, including: making people with post-traumatic stress disorder eligible for a certain type of case management and creating a program to support people first experiencing bipolar disorder.

For children, lawmakers are looking at funding for behavioral health services linked to schools and a "wraparound" program to help families build their support systems.

Legislators are also considering money for a mental health collaboration pilot program to help move youth with mental health needs from inappropriate settings, such as juvenile detention, to supportive facilities.

Many mental health proposals could take years to bring change, but county workers said the crisis in juvenile detention is immediate. A study last June found 20% of juveniles in Minnesota detention facilities were boarding there because of mental illness.

Those facilities are "woefully underfunded" to meet the kids' mental health needs, said Matt Bauer, who oversees the Dakota County Juvenile Services Center. He said he had hoped to see grants for detention centers to provide those services, but he said the idea didn't progress this legislative session.

"We can't avoid this conversation any longer," Bauer said. "We're the stop-gap in the state of Minnesota for these kids when they have nowhere else to go."

Like adults, young people with some of the most serious mental and behavioral health needs can face long waits for placement at psychiatric residential treatment facilities. Those providers can reject young people for a range of reasons.

Lawmakers want to create a working group to recommend ways to expand psychiatric residential treatment services and grant $1.2 million to Clay County to start work on a facility there.

Nowhere else to go

Wood's daughter was on a waitlist before getting into a residential treatment facility in March. After a crisis in January, she cycled back and forth between the emergency room and a walk-in center meant to stabilize kids in the short term.

Her daughter and their family feared she couldn't control her impulses and would hurt someone if she returned to their rural Goodhue County home, Wood said. But they couldn't find anywhere else to take her. At one point, the hospital said it was going to involve child protection services.

Hospitals frequently reach out to child protection because county staff help families access services, said DeLong of Children's Minnesota. He stressed that the workers are there to find support, not just take kids away.

Lawmakers are looking at changing state law to clarify it is not child neglect for a child to remain in a hospital when they can't safely return to their family and when services like residential treatment are not available.

"No parent wants to have to board their kid in a hospital," Wood said. "We do it because we love her, because we want her to have access to people who can help her special needs in the same way we would bring her to the hospital if she was having unrelenting seizures or appendicitis."