Funding becomes a sticking point in Alabama suicide and crisis hotline bill

By: - May 16, 2023 7:00 am
ADMH Commissioner Kimberly Boswell discusses the state's mental health initiatives at its February board meeting.

Kimberly Boswell, commissioner of the Alabama Department of Mental Health, said that the telecom surcharge is necessary due to historically underfunded mental health services in Alabama. (Alander Rocha/Alabama Reflector)

A bill to provide funding for a suicide and crisis hotline encountered opposition in a  House committee last week.

But supporters of HB 389, sponsored by House Ways and Means General Fund chair Rex Reynolds, R-Huntsville, are optimistic it can pass into law in the final nine days of the current session.

House Ways and Means General Fund Committee chair Rex Reynolds, R-Huntsville, speaks during the session of the Alabama House of Representatives on Tuesday, March 14, 2023. (Stew Milne for Alabama Reflector)

The bill would create the 988 Crisis System of Care Act and require the Department of Mental Health to develop, coordinate, and administer Alabama’s mental health care initiative. That would include supporting 988 Crisis Call Centers and the 988 Suicide and Crisis Call Lifeline.

The bill would also set up the 988 Commission, which would serve as an advisory body of the 988 Crisis Care Fund, and the commission would be responsible for developing a mechanism that would provide a hardship waiver process for individuals who cannot pay the 98-cent user fee.

Ingrid Hartman, director of quality assurance at AltaPointe Health, a crisis center in Mobile, said that having local crisis centers increases the likelihood that someone will get the services they need.

AltaPointe serves 16 counties, she said, and she knows all the services available in Mobile, Baldwin and Washington county. In other counties, AltaPointe has relationships with other providers that they can connect with to provide care to those in crisis.


“It’s a little bit easier being in Mobile or Baldwin,” she said. “I know our crisis center and I know our staff there, and I can pick up the phone and say, ‘Hey, I’ve got this adult and he’s unable to come in, can we send our crisis response team?’”

These crisis centers took in more than 1,500 people who might have gone to an emergency room in 2022, and 500 people who otherwise would have otherwise gone to jail.

Opponents of the bill were not against the hotline, but the way it would be funded. The funding model, based on a proposal from the Alabama Department of Mental Health, would require that telecommunication companies pay a baseline surcharge of 98 cents per cell phone line.

Jake Lestock, director of state legislative affairs at CTIA, an association representing the wireless communication industry, said other states have pursued alternative funding models, such as federal funds or direct allocations from state budgets. 

Five states have enacted the legislation that funds these services via a telecommunication surcharge, Lestock said, and that Alabama’s would be the highest, at more than double the rate in Washington state (40 cents).

“Per-line taxes are very regressive, imposing proportionally higher burdens on low-income families, especially those with multiline accounts or family plans.

He said that Alabama already has a high 911 surcharge at $1.86 per line per month, and the additional 988 surcharge would likely add a burden to low-income families.

Alabama Department of Mental Health (ADMH) Commissioner Kim Boswell said that while the proposed surcharge is higher than other states’, mental health services in Alabama have been historically lacking, and there is much to catch up on.

“For 10 years, from 2010 to 2020, the Department of Mental Health didn’t receive any increases in funding for mental illness service,” Boswell said. “And so it is true that we’re having to make up for having not funded our system of care for 10 years.”

Boswell said she would support amendments to establish a hardship waiver process for individuals who cannot pay the 98-cent user fee.

Other amendments would provide that the Alabama 911 Board, the same organization that currently collects 911 fees, will collect 988 fees and that telecommunication providers would follow the same processes to collect the 988 user fees they already do for 911 user fees. Additionally, there is an amendment to cap the surcharge at 98 cents, previously the baseline amount.

Dave Hargrove, regional director for government affairs at AT&T, suggested the committee fund these services through the General Fund budget, as opposed to imposing a surcharge on customers.

“As filed in the bill, this new fee, or tax, would amount to approximately $70 million annually, if imposed that 98-cent per line,” he said.


But Boswell said that asking for $70 million more from the General Fund budget would be unsustainable in the long run. She said that in case there is an economic downturn, the extra funding for the Department might be at risk of being cut. 

Having a fee that is not contingent on the economy and that is not contingent on other competing priorities within the General Fund, she said it is a creative way to fund crisis services across the state.

“They’ve made a huge investment to turn around and then ask for $68 million more of the General Fund is, frankly, just not reasonable,” Boswell said.

The committee is scheduled to discuss the amended bill on Wednesday. Reynolds, the bill sponsor and committee chair, said in a phone interview Monday that he took nearly 20 amendments from Boswell, and that they have spoken to all parties to address concerns and improve the bill.

“We’ll continue to work it through the day today and into tomorrow, and then make a final decision for Wednesday,” he said.

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Alander Rocha
Alander Rocha

Alander Rocha is a journalist based in Montgomery, and he reports on government, policy and healthcare. He previously worked for KFF Health News and the Red & Black, Georgia's student newspaper. He is a Tulane and Georgia alumnus with a two-year stint in the U.S. Peace Corps.