President Bush's Medicaid Reform Proposal:
A Threat to Public Mental Health
Statement of
Laurel Stine, Director of Federal Relations at the
Bazelon Center for Mental Health Law
We are troubled by the crisis facing state Medicaid programs across
the country, but have grave concerns about the Administration's
proposed policy to drastically change the program.
It is not only states that are feeling the pinch but also the nation's
poor, many of whom rely on Medicaid to access needed mental health
services. The President's proposal would put at great risk the safety
net that millions of Americans with mental illnesses count on -
a protection that is all the more important in these hard economic
times.
Currently, Medicaid pays for about half of all community mental
health care furnished through state public mental health systems.
By allowing states to reduce eligibility and benefits to Medicaid
recipients, the Administration's proposal risks the increased homelessness,
institutionalization and criminalization that can result from untreated
mental illnesses.
Significant reductions in Medicaid-funded services would prove
disastrous for people prioritized by public mental health systems
- low-income Americans with the most serious mental disorders, like
schizophrenia, manic depression, depression, attention deficit disorder
and autism. Such cuts would exacerbate the current crisis in public
mental health systems by reducing systems' capacity to serve some
of America's most vulnerable populations.
Adults and children with mental disabilities would be hit particularly
hard if states opt for the Administration's proposed reductions
in benefits for people covered under Medicaid's optional eligibility
categories.
Included in this group are children from families whose incomes
are just over the poverty line but who are either uninsured or have
insurance that has extremely limited mental health coverage. Children
with severe mental disorders-a group that represents 7-11 percent
of all children in the country, according the Surgeon General- must
have access to in-home services, day treatment and other intensive
community services not covered by private insurance, as well as
to medications and therapy.
Across the country, children's mental health needs are often left
unmet. The Administration's proposal would exacerbate the problem
by further reducing coverage of services for children with mental
disabilities.
Adults who have high medical costs can also be covered under Medicaid's
optional eligibility criteria. Inclusion in this category allows
Medicaid to cover services for people with schizophrenia whose incomes
are too high to otherwise be Medicaid-eligible, but who would be
unable to afford essential mental health care they need to continue
their lives in the community.
Reducing coverage for these optional populations to a package similar
to private insurance appears to be the Administration's preferred
option. But this approach would deny adults and children with mental
disorders the critical intensive services that are only available
through the public mental health system.
The Bazelon Center believes that the Administration's proposal
is reckless and would needlessly put millions of Americans with
mental health care needs at risk.
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The Bazelon Center for Mental Health Law
is the nation’s leading legal advocate for the rights of people
with mental disabilities.
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