For the first time, states would have the option to provide inpatient care for drug addiction in mental hospitals for 30 days under Medicaid without seeking a waiver, under the Support for Patients and Communities Reauthorization Act (H.R. 4531) passed by the U.S. House of Representatives in a vote of 386 to 37, on December 12.
H.R. 4531 “makes permanent a requirement that Medicaid programs cover medication-assisted treatment for individuals with substance use disorders.” States could treat addiction in mental hospitals.
The Senate Finance Committee approved legislation with similar provisions in December, and they are supported by the American Hospital Association, so enactment looks likely.
Medicaid a Good Fit?
While there is overlap, treatment for substance abuse and mental illness is not the same, but substance abuse and homelessness are so prevalent that hospitals are now turning into mental health wards and detox facilities, says Linda Gorman, director of the Health Care Policy Center at the Independence Institute.
“The evidence suggests we know too little about drug/alcohol abuse treatment to make determinations about residential versus nonresidential programs,” said Gorman. “The families of people who are mentally ill plead for hospitalization/residential treatment and there is a fairly large literature suggesting improved outcomes from residential care or supported housing. But the ‘treatment’ periods are far longer than a month.”
Medicaid currently pays for care of acute illnesses in hospitals, and is better suited to that task, says Gorman.
“Severe mental health problems caused by brain-based diseases are more likely to be long-term chronic illnesses,” said Gorman. “If one is going to do a program expansion, it might make more sense to develop block-granted, separate state-run programs.”
‘Bring on the Caregivers’
The reason for expanding in-patient treatment is unclear, but it will be a financial bonanza for the mental health industry, says John Dale Dunn, M.D., J.D., a physician and policy advisor to The Heartland Institute, which publishes Health Care News.
“I am not sure what the drive is to create a health care handout for mental health disorders since access to Medicaid is already present and used to an incredible degree,” said Dunn.
Dunn says the legislation will be a boon for psychiatric professionals and treatment facilities.
“Sleep disturbance, dysphoria of any kind, unhappiness—so bring on the caregivers with medications, counseling, or various therapies included in the payment categories for Medicaid,” said Dunn.
Kenneth Artz (KApublishing@gmx.com) writes from Tyler, Texas.