MHw: Medicaid, Budget Issues, Service Access Concern MH Field As Election Nears

Medicaid, Budget Issues, Service Access Concern MH Field As Election Nears

Mental Health Weekly September 24, 2012


With just six weeks left before Election Day, budget and reform proposals on Medicaid and Medicare spending, access to mental health care services, and full parity implementation are weighing heavily on the minds of mental health advocates and the field in general, as is the need to encourage its members and clients to vote.


“Looking beyond the election, there’s a lot at stake for entitlement programs like Medicaid and Medicare,” Rebecca Farley, director of policy and advocacy for the National Council for Community Behavioral Healthcare (National Council), told MHW. Over the last few years, the field has seen a few different proposals to reform Medicaid, she said.


The budget plan proposed by Rep. (and vice presidential candidate) Paul Ryan (R-Wisc.), which was passed by the House of Representatives only, looks to convert Medicaid to a block grant program, Farley noted. That would mean that rather than being reimbursed  under a fee-for-service system with federal matching funds, states would receive a fixed amount to be spent on Medicaid.


Proposals to repeal the maintenance of eligibility (MOE) are also being considered as part of the House Budget Reconciliation process, Farley noted. MOE provisions have helped to maintain access to affordable coverage and stem the in-crease in the uninsured during the recent recession when demand for public programs rose and state revenues fell, according to the Kaiser Commission on Medicaid and the Uninsured.


Without these requirements, more states would have made coverage reductions due to budget pressures, according to the commission. Under the proposal, more Medicaid enrollees are at risk. The overall concern regarding Medicaid, said Farley, is that fewer resources could be available to support the program.


“We want to make sure that the services beneficial for people on Medicaid are preserved,” said Farley. “We would like to see policymakers of all stripes working as diligently as we are to preserve mental health services and strengthen the mental health and addiction safety net in this country.”


Farley added, “We’re monitoring proposals from both sides of the aisle.” The National Council plans to work with the new Congress in 2013 as it addresses Medicaid, Medicare and Social Security issues, she said.


The current administration has taken some important steps to improve Medicaid, including supporting passage of the Affordable Care Act (ACA) that includes a variety of Medicaid reforms designed to expand opportunities for people with disabilities to live and work in integrated settings, said Jennifer Mathis, deputy legal director of the Judge David L. Bazelon Center for Mental Health Law.


“There is much work to be done to ensure that more participants in Medicaid programs get the services they need,” Mathis told MHW. “We hope that whichever administration is in power will take a strong stand in promoting the reallocation of Medicaid dollars to more effective and less costly community services.”


The specter of sequestration, across-the-board cuts put into place as part of the Budget Control Act, continues to loom large over the field. The legislation established caps on discretionary spending for over 10 years, resulting in $1 trillion in cuts spread across defense and non-defense discretionary (NDD) programs, such as community services, housing and mental illness research.


Farley pointed to a new report, “OMB Report Pursuant to the Sequestration Transparency Act of 2012,” released by President Obama on Sept. 14. “According to the report, SAMHSA could be subject to an 8.2 percent cut if sequestration goes into effect,” Farley said. “The report does not detail how that would be apportioned among the SAMHSA programs nor how much of it would fall on the block grants.”


Other concerns, noted Farley, include a proposed 27 percent cut in the Medicare physician payment rate on Jan. 1, 2013, called for in the Budget Control Act’s sequestration provision. In previous years, Congress has attempted to avert the payment cut to physicians who treat Medicare patients, but these deferrals have always been a temporary fix, said Farley. “We’re in the same position this year,” she said.


The National Council and other advocacy groups have urged members to contact their legislators and press to preserve mental health spending. “We have to do our best to preserve services and access,” Farley said.


Ongoing issues

The Coalition for Whole Health (CWH), composed of more than 70 mental health and addiction organizations, formed in 2008 and have pulled together their collective weight to ensure that behavioral health issues became an integral part of the healthcare reform discussion in that year’s presidential race (see MHW, Jan. 14, 2008).


As they did in 2004, the CWH organized recovery rooms at both the 2012 Democratic and Republican National Conventions, in Charlotte, N.C., and Tampa, Fla., respectively, said Sita Diehl, director of state policy and advocacy for the National Alliance on Mental Illness (NAMI). NAMI is a founding member of the CWH, she said. Recovery rooms were established by the CWH to raise awareness of mental health and substance abuse issues in each party’s platform.


Former Rep. Patrick Kennedy (D-R.I.), who helped organize the recovery rooms, was a guest speaker at the Recovery Caucus meeting at the Democratic convention to discuss implementing regulations for full mental health parity - an event that was standing room only, Diehl said.


Kennedy and former Rep. Jim Ramstad (D-Mich.) are in the midst of conducting field parity hearings around the country to continue pressing for the final rule for the Mental Health Parity and Addiction Equity Act (MHPAEA) into place (see MHW, May 14). “We’re happy that the parity hearings are receiving such so much attention,” said Diehl.


Olmstead, employment

“We think the current administration has done a tremendous job in stepping up enforcement of Olmstead,” said Mathis. In recent weeks, Olmstead-related settlements have been reached in North Carolina (see MHW, Sept. 10) and Virginia between state mental health department officials and the U.S. Department of Justice (DOJ). “We hope that such enforcement efforts will continue under either an Obama or a Romney administration,” Mathis said.


The current administration has taken some important steps to promote employment of people with disabilities, said Mathis. “Among other things, the President’s Executive Order requiring the federal government to hire 100,000 people with disabilities over five years has brought significant changes,” she said. “Proposed regulations that would strengthen federal contractors’ obligations to recruit and retain people with disabilities would also make a big impact, and we hope that those regulations will be finalized whether in an Obama or a Romney administration.”


Mathis added, “We are encouraged to see that the Republican platform endorses the idea of “Employment First” - that employment is the expectation for people with disabilities. We have concerns, however, that the platform is silent regarding federal contractor and federal government hiring of people with disabilities, and that the only strategy mentioned is the Ability One program, a sheltered work program. Virtually all people with disabilities are capable of working at “real jobs” and earning regular wages, she said.


Election-related activities

NAMI has launched a campaign, “Mental Health Gets My Vote,” for its members to connect with the candidates to learn where they stand on improving access to mental healthcare, dealing with housing issues for people with mental illness and addressing the mental health workforce shortage.


“We’re taking a more grassroots approach this year,” said Diehl. “We have crafted questions, an action agenda and kits for NAMI members and the public,” she said. NAMI is also encouraging members to visit the candidates’ websites and link to their Facebook and Twitter pages.


NAMI has also partnered with Protection and Advocacy (P&A), the federal organization charged with helping to implement the Help America Vote Act in 2003 to ensure individuals with disabilities participate in the electoral process. NAMI’s state action agenda for 2012 includes nine policy objectives, said Diehl. Its top three are protecting mental health funding, expanding access to mental healthcare and ensuring that effective mental health services are available, she said. “Recovery should be a possibility for everyone,” Diehl said. •


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