On those chilly nights in 2022, Dulcelina Miranda appreciated the electric blanket her brother gave her, along with an adapter that allowed her to charge it in her Toyota Camry.
When she couldn’t find a friend or relative’s couch to sleep on, she warmed the blanket while driving, then parked and slept for a few hours until the heat leached away. Miranda was getting her masters degree in social work at Simmons University, yet she was essentially homeless as she balanced part-time classes and homework, while spending a minimum of 24 hours a week in mandatory, unpaid, or poorly paid, field work.
“I knew that if I got a job with the undergrad degree that I had I wouldn’t get paid enough to live on my own,” said Miranda, 28. “If I finished my masters I’d be OK.”
Last year, Massachusetts established a $192 million behavioral health trust fund, in part to prevent people like Miranda from facing such gut-wrenching decisions. The fund supports an array of incentives to attract and retain workers in behavioral health fields, including scholarships, loan repayment programs, and compensation for unpaid internships. But despite an urgent need to counter a serious behavioral health labor shortage in the state, the money has almost entirely stayed in the hands of the Executive Office of Health and Human Services.
HHS officials say some of the money, about $75.8 million, will start flowing this fall, including $25 million for scholarships, $25 million in stipends for student field work or internships, and $3 million to cover behavioral health licensure fees through the Department of Public Health.
But more than half of funds, $100 million, are for a loan repayment program that’s highly anticipated in an industry struggling to retain workers. In the fall, the state will begin taking applications, but that money won’t begin to reach loan servicers until March 2025, at the soonest, HHS reported.
HHS originally planned to distribute the money in December 2025, said several officials with knowledge of the program. The agency moved up its date last month after receiving pressure from several senators, they said.
“It’s paramount we get these resources out the door to providers as soon as possible,” said state Senator Julian Cyr, a Truro Democrat who was among those urging HHS to distribute the money sooner than later. “I’m encouraged that the administration accelerated their timeline for the loan repayment program.“
The $100 million loan repayment program is the single largest initiative supported by the fund. Of the program’s total, $30 million has been used to support applicants for a 2023 iteration of the repayment program, said Cecille Avila, an HHS spokesperson. The remaining $70 million fund is one of among nine complicated loan repayment programs managed jointly by HHS and the Massachusetts League of Community Health Centers. About 9,000 people applied to six of those loan programs launched since 2022, Avila said. Distributing the money equitably has been time consuming, she said.
The student loan repayment program is available to mental and behavioral health workers who commit to four years of full-time work with the state and prioritizes lower-paid workers and workers from diverse backgrounds. The repayment amount available is scaled based on workers’ jobs and education levels.
“There’s a behavioral health workforce crisis and we need those funds,” said Rebekah Gewirtz, executive director of the National Association of Social Workers chapters in Massachusetts and Rhode Island.
The health care industry as a whole is struggling with a workforce shortage but the lack of behavioral health workers has proven to be especially hard to address. More than a quarter of licensed clinician positions in behavioral health are unfilled, according to a study released this week by the state’s Center for Health Information and Analysis. Close to 1,500 patients each day wait in the state’s hospitals, sometimes for months, for care, because there are not enough workers to staff licensed inpatient psychiatric beds, according to a May report from the Massachusetts Health and Hospital Association.
“Here we are now in 2024, we still have workforce issues,” said David Matteodo, executive director of the Massachusetts Association of Behavioral Health Systems, “and the money has just been delayed.”
The $192 million is what remains of $400 million from the American Rescue Plan Act’s 2021 pandemic relief to Massachusetts, hailed at the time as a windfall for overwhelmed behavioral health services.
Half of it was put to work quickly. About $110 million for mental health providers formed the backbone of a $140.9 million student loan repayment program last year that benefitted 2,935 workers, HHS reported. The rest of the money supported in-person behavioral health services, workforce development, and technology upgrades, among other programs.
The remaining funds became the object of a tug-of-war between then-Governor Charlie Baker and the state legislature over who would get final say over how the money was used. It wasn’t until last year that the legislature followed recommendations of a commission, which Cyr led, that recommended uses for the remaining relief dollars and approved the use of the money in last year’s budget.
Many of the programs the fund would support are new, and have taken time to launch, Cyr said. The student loan repayment program, though, builds on an existing initiative.
“Whereas the other programs are going to take some time to stand up, the loan repayment is about retention, and we need to retain as many providers as possible,” he said.
Miranda, who now lives in Roxbury, said if she had a stipend during her internships, “I wouldn’t have been living out of my car, I wouldn’t have been on EBT.”
In early 2023, she received a $10,000 fellowship which, in combination with a new, paid internship, allowed her to get her own apartment. Now, she plans to start work as a clinician with the Department of Youth Services in July. She’s leaving school with nearly $50,000 in student loans, though, and is already planning to apply for the repayment program.
“If I’m stressed out in life, and I’m worried about my basic needs, then I can’t really provide my clients with the level of care they really need,” Miranda said.
Jason Laughlin can be reached at [email protected]. Follow him @jasmlaughlin.