Working for change


ADVOCATES CHIP AWAY AT DISCRIMINATORY POLICIES


Chapter 3




Some say the designers of the Medicaid and Medicare rules had good intentions.
Congress didn't want to pay for long hospitalizations for psychiatric patients because the goal was to move people out of big asylums and into communities, Kennedy says.
Others note that the rules serve a useful purpose today because they encourage states to focus on outpatient treatment. "They create incentives for states to serve people where they ought to be served," says Dennis Jones, the former mental health commissioner for Indiana and Texas.
In 1963, Kennedy's uncle, President John F. Kennedy, signed legislation to create a network of community mental health centers across the country.


“'Every parent I know has to fight for treatment for their child.'”
LAURA POGLIANO
But the nation never followed through, Manderscheid says. While many of the old hospitals have closed, the country built fewer than half of the planned 1,500 mental health centers. Hospital beds, meanwhile, have shrunk from a peak of more than 500,000 in the 1950s to just over 100,000 today.
"It's an unfulfilled promise," Glover says. "There needs to be a balance of community based-services and inpatient care."
Over the decades, Congress has relaxed Medicaid's policies somewhat, Honberg says. In the 1970s, Medicaid began paying for psychiatric hospitalizations for patients under 21. In the 1980s, it began paying for psychiatric hospitals with fewer than 16 beds.
But Congress is unlikely to completely eliminate the unequal Medicaid rules, Glover says. Paying for unlimited inpatient psychiatric hospitalizations would likely add several billion dollars to the Medicaid budget — a non-starter for many in Congress, he says.
But the Affordable Care Act is paying for a pilot study of what happens when Medicaid further relaxes its payment rules.
The $75 million study provides 11 states and the District of Columbia with federal Medicaid matching funds for people who need emergency inpatient psychiatric care. Some states offer additional services. Early results from the national pilot study, released in December, show that patients had relatively short hospital stays — an average of eight days — with few needing to be rehospitalized within the same year.



  By denying hospital care to the mentally ill, Rep. Tim Murphy (R) says Congress
                                                effectively tells the mentally ill they are less deserving of a decent life than others.

                                             Murphy's bill also aims to help more people get short-term                                                            inpatient care.
His Helping Families in Mental Health Crisis Act would allow states to receive Medicaid matching payments for adult psychiatric hospitalizations, Murphy says. The bill has won support from a number of medical and mental health organizations, including the American Psychiatric Association, the American College of Emergency Physicians and the National Association of Psychiatric Health Systems.
Rep. Ron Barber, D-Ariz., also has introduced legislation to expand hospital care. His bill would eliminate Medicare's 190-day lifetime limit on psychiatric hospital care.
"It's a gaping hole we've got to fill," Barber says.




Yet at a time when Congress is deeply divided -- and members are preparing for an election -- mental health advocates say the bills face an uphill battle. Even if the bills don't pass as written, Manderscheid says he hopes Congress will craft a compromise to make some progress in providing care.
Laura Pogliano of Towson, Md. has often paid out-of-pocket for the care of 22-year-old son, who has schizophrenia. He frequently has needed care that wasn't covered by insurance. Other times, he couldn't wait for a public hospital bed to open up.
In less than three years, Pogliano says, she exhausted all $250,000 of her life savings. She lost her house when she chose to pay his hospital bills instead of her mortgage payments. "Every parent I know," she says, "has to fight for treatment for their child."








Pasted from <http://www.usatoday.com/longform/news/nation/2014/06/25/stigma-of-mental-illness/9875351/>