Letter to the Editor

Mental healthcare will gain from Medicaid extension

Wednesday, March 27, 2013

Dear editor:

The debate on whether to extend Medicaid coverage in Missouri to 138 percent of the federal poverty level is an issue that is important to all citizens. Strengthening Medicaid through federal funding available under the Affordable Care Act (ACA) also has major implications for Missouri's mental health system.

If eligibility is extended, nearly 50,000 of the 300,000 newly eligible Missourians would receive behavioral health services through Department of Mental Health (DMH) funded community treatment and support programs. Many will be young adults, between the ages of 18 and 30, with developing mental illness such as schizophrenia or bipolar disorder.

By extending Medicaid coverage, Missouri will get back $1.8 billion of its federal taxpayer dollars in each of the first three years and $2 billion annually thereafter. A University of Missouri study says extending Medicaid in Missouri generates 24,000 new jobs for the state in healthcare and related professions. Medicaid expansion will reduce the number of individuals who seek their healthcare through hospital emergency rooms and therefore reduce the overall cost of healthcare.

As much as there is a great benefit to the public mental health system by extending Medicaid coverage, there is an equally great danger for the system if Medicaid is not extended. The danger lies in the fact that to help fund extending coverage, federal reimbursements for "uncompensated care" for indigent hospital patients, often called "disproportionate share" (DSH) payment, will be reduced by 50 percent. Hospitals that DSH payments will have to make up for that loss by cutting the services that rely on that funding stream -- notably the psychiatric units, which have the highest percentage of indigent patients.

Missouri has lost over 1,400 psychiatric hospital beds since 1990. This additional loss of acute psychiatric beds will create even greater problems for county sheriffs and city law enforcement departments that must transport these patients, often for long distances, in search of a psychiatric inpatient bed. Local law enforcement officers already stay at the hospital emergency rooms and inpatient units for many hours as these patients are admitted to care. This situation will worsen.

Strengthening Medicaid in Missouri will enhance public safety and improve public health by providing earlier intervention for people developing serious mental illness and substance use disorders. Not extending Medicaid eligibility will have a significant negative impact on Missouri's mental health system, particularly on psychiatric inpatient services.


Gary Duncan

Missouri Mental Health Commission and former president and chief executive officer of Freeman Health System in Joplin