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Medicaid: A vital lifeline for mental health care

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In December 2016, Congress enacted landmark legislation to improve care for Americans with mental illness. These provisions reflected strong, bipartisan consensus that fixing the broken American mental health system must be a national priority and something we cannot ignore.

Today, barely two months later, Congress is considering changes to Medicaid that could significantly set back the cause of improving mental health care and deny care to millions of Americans with mental illness.

{mosads}Medicaid is the most important funder of services for people with mental illness in the U.S. About one-third of people added to Medicaid in the states that have expanded this program live with a mental illness or substance use condition. Many of these individuals live with the most serious mental health conditions, and are vulnerable to hospitalizations, homelessness or involvement in the criminal justice system.

Medicaid provides people with access to services that private insurance policies typically do not cover. They include Assertive Community Treatment (ACT), an evidence-based practice with a long track record of success, in which mental health workers reach out to help persons where they live, rather than wait for them to come to see them.

Medicaid is also important as a catalyst for early identification and intervention in the treatment of emerging mental illness. These services enable young people to remain in school and work. It keeps them on the trajectory of life-long success, preventing long-term dependence on public support.  

Governors throughout the country know how important Medicaid is for people with mental illness. Ohio Republican Gov. John Kasich recently wrote to key members of Congress, describing how Ohioans with mental illness and addictions have benefited from his state’s decision to expand Medicaid. These benefits included significant improvements in overall health status, reductions in use of emergency rooms, higher rates of employment and reductions in the numbers of people uninsured. Kasich urged Congress to give states “the flexibility to retain the adult Medicaid coverage expansion and federal matching percentage.”

Every week, the National Alliance on Mental Illness (NAMI) hears from individuals in other states who also benefit from Medicaid. One woman, Crystal L. of Arizona, credits Medicaid for helping her to recover and pursue a goal of getting back to work.

“Now I am getting training so I can help others as a peer-support specialist,” she explains, providing help, based on her own experience, to other persons with mental illness who are working toward recovery.  She worries that if Congress repeals Medicaid expansion, she “will lose [her] life-saving programs, and treatments when [she is] so close to returning to work and independence.”

Untreated mental illness exacts a tremendous toll on America.  Mental health conditions are the number one cause of disability and workplace absenteeism.  Suicides are at a 30-year high. About one-third of the homeless population live with mental illness.  Among chronically homeless individuals, it’s 80 percent. Simply put, mental illness touches the lives of all Americans.

Mental illness does not have to be a path to disability and dependency. With appropriate treatment and services, Americans can and do recover. Because of Medicaid, Dustin M. of Pennsylvania said “I was able to get a job, which I have had for almost seven years now.” Medicaid paid for him to participate in an outpatient “clubhouse” program, “which has given me the skills to succeed and graduate from community college with an Associate’s Degree.”

Mental illness has been in the shadows for too long. We have only recently begun to make progress in understanding and responding compassionately to people with mental health conditions. Congress took a big step forward when it passed the 21st Century Cures Act in December. Rolling back Medicaid expansion or capping federal funding of Medicaid would take two steps back. As a nation, we need to keep moving forward in improving care and recovery for people with mental illness.

Mary Giliberti, J.D. is Chief Executive Officer at the National Alliance on Mental Illness.

The views expressed by this author are their own and are not the views of The Hill.


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