Don't Reduce Services If You're Going to Expand Coverage
A few months ago, I wrote about an aspect of the Affordable Care Act that made me happy - namely, the requirement that insurers cover treatment for mental illness to the same degree as they cover treatment for physical illnesses. This was a significant victory for people experiencing mental illness and their families because it recognizes that mental health care is just as important as other types of health care.
I'm still happy about this, but another article that appeared recently in the Chicago Tribune opened my eyes to the larger picture surrounding the expansion of mental health coverage. Keep in mind that the article focuses on Illinois, but I imagine that several other states are dealing with these circumstances. From the article, I learned that through the Affordable Care Act, mental health coverage is also expanding for the seriously mentally ill who previously had no coverage. These folks are now eligible for Medicaid, which will pay for mental health services such as individual and group therapy, residential treatment, and psychiatric services including medication management.
Under the new guidelines, Illinois expects over 140,000 new Medicaid enrollees who need mental health services. Sounds great for them, right? And it will be great for them - as long as there are actually enough providers available to deliver those services.
Long before the Affordable Care Act was implemented, Illinois was experiencing a serious shortage of psychiatrists and other mental health professionals, particularly in impoverished neighborhoods where many of the most seriously mentally ill are found. To make matters worse, Illinois' budget for mental health services was cut $113 million between 2009 and 2011. Among other closings and staff reductions, these cuts resulted in the closing of 6 of the 12 mental health clinics in the city of Chicago.
That's right - half of Chicago's mental health clinics are gone. The remaining clinics are so understaffed compared to the influx of displaced clients that they have decided to turn down new Medicaid clients and only see current clients who enroll in Medicaid while already receiving services.
How in the world are we going to meet the mental health needs of the tens of thousands of new Medicaid clients who sign up under the Affordable Care Act when we don't even have enough mental health providers to serve our current client population?
This was bad, bad planning. Actually, it was simply "non-planning." I'm not saying that new enrollees don't need or deserve services, because they very much do. I'm simply saying that we shouldn't make promises we can't keep. I'm going to be watching this closely and praying that my worst fears are not realized.
Graham, J. (January 9, 2014). Mentally ill, poor - but insured: Psychiatric coverage expands; resources are a question mark. Chicago Tribune (Online Kindle version).