Medicaid is a public health insurance program that is jointly funded by the states and the federal government. Medicaid provides health insurance coverage for nearly 60 million low-income adults, children, pregnant women, seniors, families and people with disabilities, including some types of mental illness.
Medicaid is the single most important financing source of mental health services in the U.S., covering nearly 27% of all mental health care in the U.S. and nearly half of the public mental health spending, according to SAMHSA. Federal law requires state Medicaid programs to provide physician care, laboratory services, partial hospitalization and, for children under 21, Early and Periodic Screening, Diagnosis and Treatment (EPSDT).
State Medicaid programs typically cover a wide variety of mental health services such as case management, peer support services and psychiatric rehabilitation that are rarely, covered by private health insurance.
While many of these services are optional for states, it is widely recognized that these services can prevent more costly crisis and long-term hospital care. Investment in adequate community-based health and mental health services can also prevent tragedies such as school failure, incarceration, homelessness and unnecessary loss of life.
Where NAMI Stands
We want to ensure that states offer the full range of mental health services and supports as part of their Medicaid programs. These services and supports should include: case management, psychiatric rehabilitation, family and peer support, supported education and employment, transportation assistance, supportive services in the home and respite care.
We want states to adopt “bundled payment” system so that evidence-based and promising practices, such as ACT and first episode psychosis services can be funded.
We want the Medicaid Early and Periodic Screening, Diagnosis and Treatment (EPSDT) requirement to be enforced in every state. It provides Medicaid-eligible children regular mental health screenings in every state.
The Institutions for Mental Diseases (IMD) exclusion should be abolished. The IMD exclusion prevents Medicaid reimbursement for psychiatric treatment of individuals between the ages of 21 and 64. This discriminates against people who require inpatient psychiatric care and this must be stopped
Medicaid should be expanded in every state with adequate mental health services and supports included in the plans. Expanding Medicaid doesn’t mean that every state has the same quality of care: while the federal government offers incentives to adopt robust plans, not all states take advantage of them. We want to ensure that every state chooses the best plan for people living with mental illness so that they can get services they need.
What NAMI Is Doing
NAMI works with our state and grassroots leaders to provide resources and advocacy tools about Medicaid and Medicaid Expansion. NAMI partners with other grassroots, nonprofit, health and disability organizations to advocate for expanded access to Medicaid services and supports.
NAMI urges Congress to fully fund federal programs including Medicaid and supports legislation that expands access to care and services for Medicaid beneficiaries. NAMI also provides feedback and information to federal agencies including the Center for Medicare and Medicaid Services (CMS) about rules and regulations implementing Medicaid. Following our successful advocacy effort that resulted in a March 29, 2016 CMS Medicaid Parity Ruling, NAMI will continue our strong advocacy efforts to ensure expansion and that they comply with this important rule.
Traditional Medicaid eligibility varies by state, but is generally limited to low-income children, women, older adults and people with disabilities who receive Supplemental Security Income (SSI).
The Affordable Care Act (ACA) allows states to expand Medicaid eligibility (the process is referred to as “Medicaid Expansion”) to uninsured adults and children whose incomes are at or below 138% of the federal poverty level (FPL), including many who live with mental illness. Not every state has opted to expand Medicaid leaving many people living with mental illness without access to affordable health insurance.
Why Are States Requesting Waivers to Expand Medicaid?
The U.S. Department of Health and Human Services (HHS) has the power to approve experimental programs that would benefit low-income people not traditionally covered under Medicaid using the Section 1115 waiver. States that did not choose to expand Medicaid can apply for this waiver to expand coverage.
States involved in the Section 1115 waiver project have taken a unique approach to Medicaid coverage using private health insurance plan options. Some have introduced cost-sharing or co-pay requirements for participants and limited certain types of coverage such as non-emergency medical transportation (NEMT). Additionally, services such as Assertive Community Treatment (ACT), psychiatric rehabilitation and housing supports–which are covered in many existing Medicaid programs–may not be covered.
Where Does NAMI Stand
Expand Medicaid in Every State
NAMI urges that Medicaid be expanded in every state with adequate mental health services and supports included in the plans. Expanding Medicaid doesn’t mean that every state has the same quality of care. While the federal government offers incentives to adopt robust plans, not all states take advantage of them. NAMI wants to ensure that every state chooses the best plan for people living with mental illness so that they can get services they need.
States Should Apply for Section 1115 Waivers
If a state has expanded Medicaid we urge them to apply for Section 1115 waivers to have adequate mental health services and supports included in the plans. Measures like cost-sharing agreements have the potential to reduce enrollment and limit access to necessary treatments. While expanded eligibility is wonderful, Medicaid expansion programs must provide people with the coverage necessary to achieve recovery.