Report: Medicaid expansion would benefit 85,000 Alabamians with mental illness

Al.com

Expanding Medicaid could help 85,000 low-income people in Alabama who are struggling with substance abuse and mental illness, according to a new report from the U.S. Department of Health and Human Services.

People with mental illness account for more than 30 percent of the low-income uninsured in Alabama, according to the report. Studies show that people with Medicaid coverage are more likely to seek care than their uninsured counterparts.

The costs of treating mental illness and substance abuse among low-income residents have typically fallen to the states. Alabama and many other states have cut the budgets of mental health agencies, resulting in the loss of state treatment beds. This, in turn, has put pressure on hospital emergency rooms, which frequently treat patients in mental health crisis.

The report highlighted some examples of improved care for mental illness and substance abuse disorders in states that expanded Medicaid. In Oregon, for instance, people newly eligible for Medicaid had a lower probability of depression.

In Alabama, expanding Medicaid could translate to 16,000 fewer people reporting symptoms of depression, according to the report.

States that expanded Medicaid also had higher rates of growth in the number of doctors certified to prescribe medication for substance abuse disorders, according to the report. According to the CDC, Alabama has the highest rate of opioid prescriptions per capita in the country.

Homeless people in Alabama, who suffer from high rates of mental illness and substance use disorders, could be one of the groups most likely to benefit from Medicaid expansion, according to the report.

The federal government is paying all the costs of Medicaid expansion through 2016, but President Barack Obama has proposed to increase that for another three years for the 19 states that have not expanded coverage, including Alabama.

States will ultimately shoulder 10 percent of the costs of expansion. Opponents of Medicaid expansion have said the costs could top $200 million a year in Alabama. Legislators have shown little appetite for increasing the Medicaid budget, and are currently considering a funding plan that would leave the agency about $85 million short of the full amount requested by the commissioner. The budget proposed by legislators could jeopardize a plan to control Medicaid costs by transitioning to managed care, said Gov. Robert Bentley.

The Legislature can override the veto with majority votes in both chambers.

Still, according to the report, some states that expanded Medicaid saved money on mental health expenditures. Connecticut, Nevada and Washington State all experienced reductions in general fund spending on mental health services after Medicaid expansion, according to the report.

"Several states that expanded Medicaid reported that they expected reductions in general funds needing to be allocated to the uninsured for treatment ranging from $7 million to $190 million in 2015," according to a release about the report.

Although Medicaid does pay for many behavioral health services, it doesn't pay for all of them. The program does not usually reimburse for the costs of inpatient treatment in freestanding psychiatric hospitals. A pilot program in California does allow reimbursement for inpatient substance abuse treatment in some qualifying programs, said Vikki Wachino, director for the Center for Medicaid and CHIP Services.

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