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About The daily Astorian. (Astoria, Or.) 1961-current | View Entire Issue (Nov. 13, 2018)
3A THE DAILY ASTORIAN • TUESDAY, NOVEMBER 13, 2018 States get more leeway to expand inpatient mental health care Waivers for larger facilities By RICARDO ALONSO-ZALDIVAR Associated Press WASHINGTON — The Trump administration today allowed states to provide more inpatient treatment for peo- ple with serious mental illness by tapping Medicaid, a poten- tially far-reaching move to address issues from homeless- ness to violence. Health and Human Ser- vices Secretary Alex Azar made the announcement in a speech to state Medicaid direc- tors, a group that represents Republican and Democratic officials from around the coun- try who are confronting com- mon, deeply-rooted social problems. A longstanding federal law has barred Medicaid from pay- ing for mental health treatment in facilities with more than 16 beds, to prevent “warehous- ing” of the mentally ill at the expense of federal taxpay- ers. Azar said states will now be able to seek waivers from that restriction, provided they can satisfy certain specific requirements. “We have the worst of both worlds: limited access to inpatient treatment and lim- ited access to other options,” said Azar, who stressed that inpatient care has to be com- bined with community-based services. “Given the history, it is the responsibility of state and fed- eral governments together, alongside communities and families, to right this wrong,” Azar added. “More treatment options are needed, and that includes more inpatient and residential options that can help stabilize Americans with serious mental illness.” The lack of in-patient treat- ment beds for people with mental illness is a common denominator among several national problems: homeless- ness, police shootings, and acts of mass violence by people with serious mental problems. Advocates said it may take a year or more to start seeing results of the new federal pol- icy. States must apply for per- mission to the federal Centers for Medicare and Medicaid Services. They must demon- strate that their plans are part of a “continuum” or range of services for mentally ill people. ‘We have decades of no movement on this issue. This is the sort of opportunity we have to take advantage of.’ John Snook, executive director of the Treatment Advocacy Center “We have decades of no movement on this issue,” said John Snook, executive direc- tor of the Treatment Advocacy Center, a nonprofit trying to broaden access to mental health treatment. “This is the sort of opportunity we have to take advantage of. “Every day there is a story about police having to shoot someone with serious mental illness or the glut of mentally ill people in the emergency room,” Snook added. “I think the gen- eral public will say the federal government is finally recogniz- ing a problem we’ve been see- ing on the ground.” A decades-old law known as the “IMD exclusion” has stood in the way of Medicaid paying for treatment in larger mental health facilities. IMD stands for “institution for men- tal diseases.” Pressure has been building on lawmakers and the admin- istration to ease the restriction, given the combination of the opioid epidemic and recurring mass shootings, from Sandy Hook Elementary School in Connecticut to the Borderline Bar & Grill in Thousand Oaks, California. The Obama administration began loosening restrictions in 2015 and last year the Trump administration cleared the way for Medicaid waivers to provide inpatient treatment for people with substance abuse problems. Azar said 13 such waivers have been approved and more are in the works. In Virginia, an expansion of residential drug treatment beds has been linked to a sharp drop in emer- gency room visits due to opioid overdose. One concern about waiv- ing the Medicaid restric- tion for mental health is that it could cause a spike in federal spending. 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