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. Advocates respond
that similar restrictions aren’t
imposed on other diseases, and
that treatment may well save
society money over the long run
by avoiding other costs.
Medicaid won’t approve a
mental health treatment waiver
unless the state can show fed-
eral costs will be no greater than
would have otherwise been the
case absent a change.
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