by Bryan Thompson, KHI News Service
A new report from the U.S. Department of Health and Human Services estimates Medicaid expansion would help 34,000 uninsured Kansans with mental illness or substance use disorders gain access to behavioral health services.
The figure represents the number of Kansans with behavioral disorders whose incomes would have qualified them for Medicaid — had the state expanded its privatized program known as KanCare — in 2014. That’s the most recent year for which figures are available.
Kansas is one of 19 states that have opted not to expand Medicaid under the Affordable Care Act. Expansion would extend health coverage to an estimated 150,000 Kansans, most of whom are low-income, non-disabled adults.
The HHS report said almost a third of low-income uninsured Kansans have behavioral health needs. That compares to a fourth of the state’s overall adult population age 18 to 64.
Amy Campbell, a lobbyist for the Kansas Mental Health Coalition, said one reason there’s so much pressure on the state’s mental health hospitals is because many Kansans don’t get treatment until their mental health concerns become a crisis.
“Slightly more than half of the people who are screened for inpatient hospitalization have never received any treatment for their mental health situation,” she said.
Campbell said the Kansas mental health system faces chronic funding issues, causing some people to go without timely access to behavioral health services.
“We are already, in some areas, triaging people at the community level for mental health treatment and substance use services,” she said. “If more people who were seeking those services had coverage, that could only improve the situation.”
Kyle Kessler, who represents the Association of Community Mental Health Centers of Kansas, said Medicaid expansion would offer low-income Kansans a way to pay for the services they need and help shore up those community programs.
“We’ll be able to retain high-quality professionals, and build upon their skills, and embrace some of the newest treatments and services, and keep people out of the community hospitals as well as the state mental hospitals,” he said.
Kessler said the 26 community mental health centers in Kansas served approximately 125,000 people last year. They expect to serve at least that many this year.
Three of the community mental health centers are county agencies and the other 23 are not-for-profit, he said.
“But we’re not for-loss either,” Kessler said. “You have to be able to pay staff to retain them, and to make the services available.”
Kessler cited the Wyandot Center, in Kansas City, Kan., as a prime example of a place where damaging cuts have been made because of a lack of funding.
“They cut dozens of staff, and some of those are prevention-oriented programs to prevent people from going into hospitals or losing employment,” Kessler said.
According to Kessler, expanding Medicaid to help uninsured patients pay for their care would help maintain a more robust mental health system in Kansas — and reduce the pressure on state and local governments to subsidize the community mental health system.
The health reform law provides 100 percent federal funding of health care costs for people made newly eligible through the Medicaid expansion for the first three years of the program, ending this year. Federal funding will cover 95 percent of the costs starting next year through 2019. From the year 2020 and beyond, the federal government will cover 90 percent of the cost.
Gov. Sam Brownback has argued that the federal government can’t afford to maintain those funding levels long-term.
Other key findings from the HHS report:
• Among low-income adults, Medicaid expansion is associated with a reduction in unmet need for mental health and substance use disorder treatment. For example, one study estimates that low-income adults with serious mental illness are 30 percent more likely to receive treatment if they have Medicaid coverage. This will be especially important to states as they work to address opioid use disorder and serious mental illness.
• Access to appropriate treatment results in better health outcomes. For example, projections on the effects of expanded Medicaid coverage suggest that if the remaining states expanded Medicaid, 371,000 fewer people would experience symptoms of depression.
• States that expand Medicaid may achieve significant improvement in their behavioral health programs without incurring new costs. State funds that currently directly support behavioral health care treatment for people who are uninsured but would gain coverage under expansion could be used for other behavioral health investments.
• Medicaid expansion also reduces costs that state and local governments and state economies incur for behavioral health problems. Treating behavioral health conditions has been shown to reduce disability rates, increase employment productivity and decrease criminal justice costs.
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