It’s time for people with severe mental illness to be covered in the long-term Medicaid program.
I realize some people with severe mental illness may misconstrue this to mean that we want to push them into a psychiatric hospital. No, long-term care simply means getting your care in your own home. Now, other disability groups can receive care in their homes, but not those with severe mental illness. Why? Because of a misguided policy that has been in place since the program began in 1965.
Here is a little bit of the history.
Long-term care for most individuals with severe mental illness is generally not covered by Wisconsin’s Medical Assistance Program. Individuals with severe mental illness are also unlikely to be eligible for waiver programs like Family Care or the Include, Respect, I Self-Direct (IRIS) program, as they require eligible individuals to have a physical or developmental disability, or be a frail elder.
In general, extended institutional care for an individual with a severe mental illness occurs in a psychiatric hospital or other facility that is classified as an institution for mental disease (IMD). Under federal law, an IMD includes “a hospital, nursing home, or other institution with more than 16 beds that is primarily engaged in diagnosis, treatment, or care of persons with mental diseases.”
Federal law permits Medicaid reimbursements to IMDs for patients under 21 years of age or over 65, but it generally prohibits Medicaid reimbursements to IMDs for all other patients. This IMD exclusion was designed “to assure that states rather than the federal government maintained primary responsibility for funding inpatient psychiatric services.”
While Medical Assistance does not cover extended stays in IMDs in Wisconsin, if a person is hospitalized in a state mental health institution because of an involuntary civil commitment, their county of residence must cover any costs that are not covered by insurance.
If you agree this needs to change, then call your federal officials and let them know you want people with severe mental illness to have access to care in their homes. It’s time we give equal treatment as we do to the other disability groups. If it is good for some with disabilities, it should be good for all.
The time is now. As a social worker, I see so many examples of why the severely mentally ill should be included in the long-term care system. For example, they often do not keep up on their household chores or their hygiene and they often go off their medication.
If they got services in their homes, I believe this would lead to a decrease in homelessness and keep many out of the judicial system, group homes and psychiatric hospitals — a win-win for all.
Adam Brabender is a social worker at Tellurian Behavioral Health in Madison.
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