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The Bazelon Mental Health Policy ReporterVolume IV : Issue 1 : Feb. 4, 2005
In this IssueA Chilly Reception(Feb. 4, 2005)—Wednesday’s State of the Union speech made clear that dramatic policy changes may be ahead in President Bush’s second term—changes that could have a profound effect on people with mental disabilities. Details remain elusive, but one thing seems clear: President Bush’s agenda for the year poses significant threats to people with mental disabilities. Medicaid and Social Security reform and discretionary-spending cuts promised in last night’s speech are likely to hit people with mental disabilities hard. The White House has previously signaled its intent to dramatically alter the Social Security and Medicaid programs, which provide critical support to millions of Americans with mental illnesses or developmental disabilities. Specific details remain a closely guarded secret, even after Wednesday’s address. However, the Administration has given some strong hints. The President’s speech focused heavily on Social Security, but comments about Medicaid made earlier this week by a key Bush Administration official have immediate significance to people with mental illnesses. Medicaid, a partnership between the federal government and states, has become the single most important public funder of mental health services. The program provides a crucial safety net for many adults with mental illnesses and families who have spent themselves into poverty after exhausting their private health insurance’s mental health benefits. Incoming Secretary of Health and Human Services, Mike Leavitt, in a Feb. 1 speech, cited the need to reduce the comprehensive services for individuals in Medicaid’s "optional" eligibility categories —something he attempted when he was Governor of Utah. His efforts there led to cuts in mental health benefits for many and the elimination of all mental health benefits for others with slightly higher incomes. In this week’s speech, Leavitt described individuals in “optional” eligibility categories as "healthy people who just need help paying for health insurance," even though many Medicaid beneficiaries with significant disabilities are covered under the “optional” eligibility categories. Diane Rowland, executive vice president of the nonpartisan Henry J. Kaiser Family Foundation, interviewed in Wednesday’s Washington Post, told the paper that Leavitt's comments this week seemed to indicate that "the potential goal here is to reduce spending on the aged and people with disabilities, who tend to be classified as optional and are the most expensive." If the Administration cuts substantial sums from Medicaid (Leavitt hinted at $60 billion over 10 years), low-income people with mental illnesses will suffer. Advocates also worry that Medicaid’s Early and Periodic Screening, Diagnosis and Treatment (EPSDT) mandate may end up on the chopping block in the Administration’s final reform plan. EPSDT is a crucial gateway to the comprehensive services that many Medicaid-eligible children with mental or emotional disorders need. President Bush’s comments in Wednesday’s address to Congress are also reason for significant concern. The President put forth a proposal to allow workers to divert some of their Social Security contributions to private savings accounts. Such a change would decrease the federal dollars available to provide Social Security benefits, and could affect Social Security Disability Income (SSDI). The current policy debate focuses on retirement benefits, but the retirement and disability programs are interwoven; many individuals receive their disability income through a spouse’s or parent’s retirement or survivor’s benefit status. Millions of Americans with mental disabilities rely on SSDI to help make ends meet. According to the Social Security Administration, roughly 3.4 million of the 6.9 million people receiving SSDI in December 2003 had a mental disability. Last night, the President promised to send Congress a budget proposal that would hold the growth of discretionary spending (for non-entitlement programs) below inflation. This gives advocates reason to fear that essential services for people with mental disabilities may find little budget support and that nascent efforts to transform America’s public mental health systems will be left to wither on the vine. Exact details on the President’s budget are not yet released, but the Bazelon Center has heard that the Substance Abuse and Mental Health Services Administration (SAMHSA) will suffer significant cuts. SAMHSA administers many important mental health initiatives, including programs of community services for children and programs to reduce suicide, prevent incarceration in jail, decrease homelessness among people with mental illnesses and more. Our nation will be a far colder place if policymakers choose to balance the federal budget on the backs of people with mental disabilities. Fiscal responsibility and improved accountability are worthwhile goals. However, drastic cuts in spending on mental health and wrong-headed attempts to reform Medicaid and Social Security will only hurt adults and children with mental illnesses and other Americans with disabilities. More Resources
Take action Now NewsbytesAdvocates Push for Passage of Keeping Families Together Act This YearThe Bazelon Center and other mental health advocates are pushing for passage this year of the Keeping Families Together Act, critical legislation to improve access to children’s mental health services and reduce families’ need to relinquish custody of their child to obtain necessary services. Senator Susan Collins (R-ME) and other children’s advocates introduced the bill in the last Congress and plan to do so again this year. Passage of the bill gained new immediacy last week following separate reports in California (see item below) and Ohio about the high incidence of children with mental health needs ending up in state child welfare and juvenile justice systems.
California Kids with Mental Illnesses Warehoused in Juvenile DetentionEach night, hundreds of California children wait for community mental health services in juvenile detention, according to a report released last week by Representative Henry Waxman (D-CA) and Democratic staff of the House Government Reform Committee. A long-time advocate for children, Rep. Waxman has drawn national attention to the number of children being warehoused in America’s juvenile detention centers. Learn More: Read the Bazelon Center Press Release on the Waxman Report Family Opportunity Act Introduced AgainSenators Charles Grassley (R-IA) and Edward Kennedy (D-MA) last week re-introduced the Family Opportunity Act (S. 183). The bill, which would expand access to Medicaid’s comprehensive mental health services, passed the Senate last year, only to stall in the House of Representatives.
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