Paying For Community Treatment
The state plan will have to address both existing and potential resources
to avoid unnecessary institutionalization. Potential resources include an array
of federal and state programs that can be dedicated to enabling individuals
with mental illnesses to live in the community. This section summarizes these
sources of funding and explains the relevant policy steps states need to take
to secure these funds.
Only if a state makes every effort to obtain funds can it make an effective
argument that it is in compliance with L.C. or that doing more is
too costly and represents a fundamental alteration to the mental health program,
thus threatening the state's ability to provide services in an evenhanded manner.
Recently, there has been renewed emphasis on reducing the use of long-term
hospital care, especially for people with the most severe mental illnesses.(4) Improved
community treatments, such as psychiatric rehabilitation, consumer peer support
and intensive case management programs, have become more widely available.
Helping to fuel this movement are continuing concerns over the relative ineffectiveness
and therapeutic limitations of inpatient care, including the dependencies it
creates, and the fact that community care is generally no more expensive than
institutional care.
Resources to meet the expansion of community services required under L.C. are
available to states from several sources, including:
- Medicaid's optional services for adults—targeted case management and
rehabilitation;
- Medicaid coverage for services furnished in small community residential
programs of fewer than 16 beds;
- Medicaid's array of comprehensive community services for children, mandated
through the Early and Periodic Screening, Diagnosis and Treatment requirement
of the law;
- Medicaid Home- and Community-Based Care Services Waiver;
- expanding Medicaid eligibility through various options and waivers of federal
rules—home- and community-based service waivers (Section 1915(c) of
the Social Security Act), research and demonstration waivers (Section 1115),
the option to cover people who are medically needy under Medicaid, and coverage
of children with serious emotional disorders under the "Katie Beckett" option
(Section 1902(e)(3));
- redirected resources created by closing or significantly downsizing state
mental hospitals, which can be applied toward the cost of community care;
- federal block grant funds;
- federal housing assistance programs;
- federal disability benefits under the Supplemental Security Income (SSI)
program; and
- state general fund appropriations for mental health services.
The following sections explain how states can use these various programs to
fund their community service systems.
|
