Bill Promotes Community Alternatives for Youth with Serious Mental Health Disorders Served by the Public Mental Health System
Bazelon Center for Mental Health Law June 20, 2012
On June 13, Senators John Kerry (D-MA) and Charles Grassley (R-IA) introduced the Children’s Mental Health Accessibility Act (S. 3289), bipartisan legislation to expand the Medicaid home and community-based services waiver to include youth in or at risk of placement in an institution called a psychiatric residential treatment facility (PRTF). Aligned with the Americans with Disabilities Act's (ADA) integration mandate and the Supreme Court’s 1999 Olmstead decision, the waiver is a mechanism for states to shift their spending on children with serious mental health disorders from PRTFs to services in home and community-based settings.
Currently, Medicaid home and community-based services waivers are available only for people who need the level of care provided in a hospital, nursing facility or intermediate care facility for the “mentally retarded.” Current law does not allow states to offer home and community-based waiver services as an alternative to a PRTF. However, many children with serious mental health disorders are at risk of placement in a PRTF, not a hospital.
In 2006, Congress created a five-year demonstration program to test the cost-effectiveness of providing Medicaid home and community-based alternatives to psychiatric residential treatment facilities. Findings indicate that serving children in their families’ homes results in better outcomes than serving them in PRTFs. Additionally, in-home intervention costs are on average less than a third of the cost of PRTF institutional costs. It is almost always less costly to provide home and community services than it is to provide institutional care.
The demonstration expires in September. The Children’s Mental Health Accessibility Act would allow states conducting the demonstration to continue home and community-based services for children already enrolled in the program. The bill would also allow all states to initiate new waivers. All Medicaid home and community-based waiver rules would continue to apply, including budget neutrality rules.
S. 3289 will enable children and youth with mental health disorders to thrive in their own homes by providing services-such as peer support, family-to-family support, supported employment, and respite care-through home and community-based waivers. The legislation would also eliminate the outdated term “mentally retarded” as it is referenced in the Medicaid waiver statute, and replace it with “intellectually disabled.”
What You Can Do
Strong bipartisan support is needed to enact S. 3289 in an election year with a lame duck session that will draw many competing priorities. Please call the Capitol Switchboard at 202-224-3121 to contact your two U.S. Senators (find yours here) and urge them to:
- “Co-sponsor S. 3289, The Children’s Mental Health Accessibility Act of 2012, introduced by Senators John Kerry and Charles Grassley.
- Support enactment of S. 3289 this year
- to promote community alternatives for children with serious mental disorders, and
- to improve mental health parity for children with mental health disorders within the Medicaid 1915 c waiver statute.
- Serving children with serious mental health challenges in their families’ homes results in better outcomes-and less than a third of the cost—than serving children in psychiatric residential treatment facilities.”
Kerry, Grassley Bill Would Expand Mental Health Services for Kids
Bi-Partisan Effort Also Strikes Offensive Term from Government Lexicon
June 13, 2012
WASHINGTON, D.C. - Senators John Kerry (D-Mass.) and Chuck Grassley (R-Iowa) today introduced bipartisan legislation to expand and strengthen mental health services for children on Medicaid. The legislation would also strike the antiquated term “mentally retarded” from the Social Security Act.
“This legislation would give families trying their best to help their children live with mental illness more options for alternative care in small settings,” said Sen. Kerry. “This is an effort to remove outdated stigmas and empower parents to help the children they love.”
“The federal government should give states incentives to use community-based settings for children with intensive mental health needs,” said Sen. Grassley. “This bipartisan legislation will give states the tools they need to provide care through smaller settings.”
The Kerry-Grassley Children’s Mental Health Accessibility Act will expand the Medicaid 1915(c) waiver to provide an option to serve children and adolescents with intensive home or community-based treatment services in lieu of being treated as inpatients in a psychiatric residential treatment facility. Without access to intensive home or community-based services, these children could otherwise be institutionalized. The waiver expansion will allow more states the opportunity to provide cost-effective care that best meets their children’s mental health needs.
Additionally, the bill will remove the term “mentally retarded” from the Social Security Act and replace it with “intellectually disabled.” In 2010, President Obama enacted the bipartisan Rosa’s Law which removed the words “mentally retarded” from federal health, education and labor laws. The Kerry-Grassley legislation builds off the successful results of Rosa’s Law by removing this obsolete term from a significant portion of the U.S. Code.
The Children’s Mental Health Accessibility Act is endorsed by over 35 major advocacy groups, including the Alliance for Children and Families, the American Psychiatric Association, the American Association of People with Disabilities (AAPD), and the National Alliance on Mental Illness.