Hope Starts With Us Episode 80 – What Comes Next for Mental Health & Medicaid

Hope Starts With Us Episode 80 – What Comes Next for Mental Health & Medicaid

The health
care system is huge and complex. If your rural hospital struggles
to stay open and now has a flood of uncompensated care
because people lose access to health insurance, if that hospital chooses to close or close certain departments,
they close for everybody, not just for people with Medicaid
or marketplace coverage. So this bill has huge effects on the U.S. health care system. I think they’re going to be ripples
that we might not even anticipate. Welcome to Hope Starts With Us, a podcast by NAMI,
the National Alliance on Mental Illness. I’m your guest host Hannah
Wesolowski, NAMI’s Chief Advocacy Officer. NAMI started this podcast because
we believe that hope starts with us. Hope starts with us
talking about mental health. Hope starts with us making information
accessible. Hope starts with us
providing resources and practical advice. Hope starts with us sharing our stories. Hope starts with us breaking the stigma. If you or a loved one is struggling
with a mental health condition and you have been looking for support,
we made this podcast for you. Hope starts with all of us. Hope is a collective. We hope that each episode
with each conversation brings you into that collective
so you know you are not alone. So today we’re talking about mental
health advocacy and some Medicaid updates. And I’m so pleased to welcome our guest
today, my dear colleague, Jen Snow. Jen’s our National Director of Government
Relations and Policy here at NAMI. And she works alongside me
on our government relations policy and advocacy team. We have a lot to break down today. Jen, thank you for joining us. Oh, delighted to be here. So, Jen, a few months ago, I was joined
by another colleague of ours, Anita Burgos and Sue Abderholden
our Executive Director of NAMI Minnesota. And that was in April. And a lot has changed since then. We were talking about Medicaid
and why it’s important for mental health. Earlier
this month, Congress passed legislation. Some call it budget reconciliation,
some call it HR1, and others are referring to it
as the “One Big Beautiful Bill Act.” This passed both chambers of Congress. It was signed into law by the president. It’s not great for Medicaid, is it? Unfortunately,
it is not great for Medicaid. And can you tell us a little bit
about takeaways from that bill and just broadly, why are these changes
to Medicaid bad for mental health care? Yeah. Thanks, Hannah. So as you said, the changes enacted in this bill
are really devastating for Medicaid. And we’ll talk more about that really over the next,
the rest of this podcast episode. But stepping back just a minute,
putting the bill in context. The bill is not solely related
to health care. The bill does a lot of other things. Primarily,
it makes some of the tax credits that were enacted during the first Trump
administration permanent. That was a big campaign promise. And certainly one of the president’s
priorities coming into office. It also rolls back
some of the clean energy initiatives
that were of the previous administration. It makes some major changes
to domestic policy related to immigration. So more money for immigration enforcement. So the bill does a lot of things
for a lot of issues that impact Americans. But when it comes to the big picture for
Medicaid and for the health care system, the enacted bill, the estimates are that
it would remove roughly $1 trillion in Medicaid
funding over the course of the decade. So $1 trillion in cuts. You know,
I honestly struggle to even think exactly how many zeros is
that, is a trillion dollars. An enormous amount of money. More important
is that the Congressional Budget Office so kind of the independent scorekeepers
for Congress, they came out with new estimates,
just a few days ago that show that they think about 10 million
people will become uninsured over the next decade due to
what is in the bill. So, you know, a huge change
in the uninsured numbers. There’s also an additional
5 million people that are estimated to lose health care coverage. It has to do with what’s not in the bill. And we can talk about that more
a little bit later. But exactly what the number is,
no one knows for sure. But, you know, we’re talking 10
to 15 million people
not having access to health insurance. The bill also makes some changes
to what’s known as a SNAP, the Supplemental Nutrition
Assistance Program. Some people might know it
more commonly as food stamps. It, the bill, cuts funding for SNAP by $186 billion. So real big cut to food
assistance programs that are also so critical to folks
who struggle with, you know, having food on their plates
and in their houses. Interestingly, the of the estimate
is that the overall bill actually increases the federal deficit
by about $3.4 trillion. So it’s one of these unfortunate
situations that it’s a lot of cuts to programs that we care about
and an increase to the federal deficit. Thanks for taking us through that. What a lot of people don’t
always understand is that even though not every person with a mental health
condition has Medicaid, Medicaid is a huge component
of our country’s mental health system. 1 in 4 dollars spent on mental health and
substance use care comes from Medicaid. A lot of rural hospitals
and other facilities operate largely on Medicaid dollars. And 1 in 3 people with a mental illness
is covered by the Medicaid program. So it’s a huge, huge component. $1 trillion sounds like a lot. Is this the worst case scenario of what we, you know,
could be anticipating with Medicaid? You know, great question. No, I am an eternal optimist
and I will say definitively that this bill,
as devastating as it will be, this is not as bad as we thought
it might be back in January. So I know when your last podcast–
when you talked with Sue and Anita, you know, I can’t remember exactly
where we were in negotiations in April, but I think we still were fearing,
a worse situation when the president came into office,
there was a lot of conversation about changing the fundamental nature
of the Medicaid program. You know, turning it into a block
granted program. Getting rid of the individual entitlement
to that benefit or, you know, just massive structural changes
to the Medicaid program. And while we– a trillion dollars
in cuts to Medicaid is enormous, it is not as bad as we anticipated
it might have been come January. And I really like to think that a lot of–
where the final bill ended up, I’d like to think, was in part
because of the advocacy from NAMI advocates,
from other health care advocates who really told their members of Congress how important
this program is to them and how, you know, significant cuts would have
a devastating impact on their lives. And, you know, as I said,
I am an eternal optimist, but it is the truth
that this bill could have been much worse. Yeah. I can vouch for Jen
being an eternal optimist. But we need that right now. And NAMI’s advocacy was a pretty big
component of the push back on this bill. We launched that Protect Medicaid, Protect Mental Health campaign earlier
this year. NAMI advocates took over 170,000 actions. And contacting Congress
and raising their voices, you know, and our NAMI alliance
really came together because I think everyone saw the threat for mental
health care and what this means. You know, something that really touched me
was that over 1500 people shared their stories
with us, trusted us with their stories so that we could use that in our advocacy
to push back on these cuts. And while it’s not ideal
what happened, as Jen mentioned,
definitely could have been even worse. We live to fight another day, essentially. The Medicaid infrastructure is intact
and we’re going to keep advocating to try to minimize the impact
of these changes on our community. So, far from ideal, but, you know, I want any advocate out there
who’s listening to know that their voice truly
made a huge difference in this effort. Beautifully said. So let’s dig into it because I’m sure people want to know
what does this mean for them? What does it mean for mental health care? A huge part of this bill that affects the NAMI community
is something called work requirements. In the bill,
it’s phrased as “community engagement.” Can you describe for us
what that looks like? And then we’ll talk about
who it applies to. Yes, absolutely. This is really, in some ways, I think, the most significant change
to the Medicaid program, because for the first time,
someone’s eligibility for Medicaid will be tied to their employment
or their community engagement activities. It really is a fundamental shift
in the way we look at Medicaid eligibility. It is also the provision
that is estimated to result in the most people losing coverage
as a result of these new requirements. So basically, what is now going to be
required is for states who have expanded Medicaid, so that is 40 states within the country, the District of Columbia, and also, Wisconsin,
kind of in a little interesting twist. They cover individuals who are often referred to as “able-bodied adults.” So these are individuals
who did not qualify for Medicaid based on, let’s say, a disability status
or a pregnancy status or being a child. These are people
who historically had not been in the Medicaid system
before the Affordable Care Act. So in the vast majority of states, the states are going to have to set up
a new system to verify whether those able-bodied adults are able to do 80 hours of work, work
or another qualifying activity, per month. So it’s 80 hours of work per–work or other community engagement activities
a month. As a result of that,
depending on how states set up the systems, people are likely going
to have to do something to either to show
that they are working for that 80 hours a month, or they’re doing some sort
of community engagement, or that they qualify for an exemption. And I should be clear. We’re saying work or community engagement. There are a few things
that count towards that 80 hours. The most straightforward ones
are work and community service. But if you’re participating
in a work program for 80 hours a month,
that would also count, as well as people who are enrolled in an educational program
for at least half time. Or you can have some combination
of those four things. As long as it adds up to 80 hours a month. That’s kind of the new threshold
for whether or not you will be eligible. There’s also two other ways
you can qualify instead of on the number of hours worked on
how much income you made. It’s a little squirrely, but,
you know, basically 80 hours a month is the big new assessment point
that will be made for individuals if they are deemed, you know, worthy
of receiving Medicaid benefits. So, you know,
during the debate around this bill, there’s a lot of conversation of like,
well, people who are on Medicaid who can work, should work, and, you know,
I think it’s important that we reiterate, we agree. In fact, most people on Medicaid do work. 92% are working in school, volunteering,
a full time caregiver. And so, you know, it’s actually really small population
that this is going to be something different. I think where the challenge comes
in, not a lot of people realize is that, people who are complying with
these requirements are going to miss the paperwork or not
report it correctly, or their time
spent working is not going to be captured accurately, and people
are going to fall through the cracks, not because
they’re not meeting the requirement, but because they haven’t reported it
correctly. And, you know, so again,
a lot of people are already doing this who are part of that able-bodied
population. But it’s not easy to navigate online
computer systems and know the deadline and know the right site and know
the process and do all of those things. And that’s where a lot of people
will fall through the cracks. You’re exactly right. And in states that experimented
with the work reporting requirements, that’s exactly what the evaluations found,
that people were dropped from coverage, not because they were ineligible
for the benefit. It was they just they
either weren’t aware of it or they didn’t submit the right paperwork
at the right time in the right order. I mean, I know just from my own personal
self when I have to fill out paperwork, you know, it’s a hassle,
it can be annoying. And, you know, there are times that you,
you know, drop something, you forget something that’s, you know, sitting on the counter that you maybe meant to do
but didn’t get a chance to do. I’d like to think that’s not just me,
that that’s a common occurrence for many people. And it’s devastating. The impact that it will have for someone
who is trying to live their lives and not necessarily, you know, spending
as much time figuring out the paperwork. Yeah. And a lot of people have questions
about this. And I want to make clear
that we still don’t know a lot. A lot of what’s in
the bill has to be further defined by the Department
of Health and Human Services. They have until next June to do that. And then states
have to figure out a system because this doesn’t go into effect
until January 1st, 2027. So folks who are listening
who may be on Medicaid or have a loved one on Medicaid, this
list is not going to affect right away. Although states may apply
to have this start sooner. And it’ll be up to the Department of Health
and Human Services whether to allow that. But the bill does not require this
to go into effect until 2027. That’s a really important clarification. And I wish that there was some way
that we could have an answer that would apply nationwide to everyone
that potentially could be listening to this that might be worried or wondering
about it, because to your point, the effective date is 2027,
but there’s the ability of states to do it earlier and we’ve yet to be seen
whether any state might try to do that. But we know that a number of states,
before this bill passed, were waiting in line, trying to be able to add work
reporting requirements to their programs. So I don’t think it’s outside
the realm of possibility that we might see some states implement this sooner than
the effective date in the legislation. Yeah. And that’s really important. And, you know,
I think the–so there’s the downside of there’s still a lot to be figured out. And we’re going to talk about
who’s exempted from this next. And that’s part
of what needs to be figured out. And then once that’s figured out, states then need to figure out their part
of how they manage this process. The upside of all that is,
it gives us time to continue to advocate which NAMI will do to try to limit
the impact of this bill on our community. So our advocacy is not over
just because the bill passed, our advocacy is going to continue
to try to minimize the impacts, on people with mental health conditions. But let’s talk about people with mental health conditions
outside of the actual work requirement. So you have to work,
but some people are exempted from that. What population is exempted
from these work requirements? Yeah. Thanks, Hannah. This is a really important
part of the bill. And when the members of Congress were
debating it, you heard a number of people point to these exemptions to say, no,
no, no, people aren’t going to be hurt. We have exemptions in here. So we are happy
that there are exemptions in place. But it’s a lot of question
about how they will be implemented and if they really will protect
the populations intended. So there is a laundry list of people
who are exempt. Just for example,
people who are under age 19, thankfully, they’re not expecting five-year-olds
to work, so that is a good thing. People enrolled
in Medicare are also exempt. Also parents, caretakers for children aged
13 and under, are exempt. So once a child hits 14,
you’re not exempt. You’ve got to prove that you’re working for parents of younger children,
you are exempt. Veterans with, disability,
a total disability rating are exempt. Pregnant women are exempt. When it comes to mental health
specific issues, there is an exemption
for people who are, quote unquote, medically frail or otherwise
have special medical needs. And then within that medically frail
bucket, it includes people specifically
with a substance use disorder and people with a quote unquote,
“disabling mental disorder.” So what does “disabling mental disorder”
mean? That’s the million dollar question. What in the world does that mean? What if you’re someone
with a mental health condition where it is disabling at different points in time? Is it– are they going to look at it when you apply
whether your condition is disabled at that moment, is it going to be based on
a certain period of time? Is it going to be based on
what a doctor says? It’s going to be based on the condition? I’m just throwing out some of
the questions that I have in my mind. I don’t have any clue
how they’re going to operationalize this definition, and I think it is
probably the most critical piece in the context of this conversation, because for people
with mental health conditions, if they are able to qualify
for an exemption under this, they would be able
to continue their health care. But if not, it’s really an open question
of whether they would then be able to continue
to have access to the health care coverage that hopefully is keeping them
healthy and engaged in the community. So there’s still just, this
I think is, again, a huge question. And over the next few weeks
continue to– weeks and months, honestly–try to think through
what are going to be our recommendations for the Secretary as he and his department
look to define this. Secretary of HHS to be clear. The Federal Department,
and the Department of Health and Human Services is
who is in charge of implementing this. And the current secretary is Robert F. Kennedy Jr. Much of the Medicaid program is implemented through the centers
for Medicare and Medicaid Services. So they will work to put out,
as you mentioned, regulations
implementing these requirements. So that’ll be a huge focus of conversations going forward. Because this this has the potential to
be able to protect some of our population. And I think an important clarification
for folks who are listening and especially in the NAMI world, just to give an example, you know,
you have your primary care physician and you have specialists
you go to, not just psychiatric care, but your dermatologist, your cardiologist, and a lot of times their health records
don’t talk to each other. So your state Medicaid program,
if it’s based on, say, a condition or symptoms, it’s not a given
that the state Medicaid program knows that people will have to prove that they meet
whatever that exemption criteria is. So a person has to know that they’re
on Medicaid, which is often confusing because Medicaid programs are called
many different things across the country. Will have to know
that this exemption exists. Will have to know
they qualify for this exemption, and will have to know how to report it and be able to report in the right way
to get the exemption. So it’s not like you wave a magic wand
and anyone who’s exempt is exempt. And everyone knows and we’re all set. There’s a lot of steps to go through
to prove you qualify for the exemption. And somebody has to be able
to complete that process. So I think that’s an important
clarification too, and something that NAMI’s going to be really focused
on educating our community about, once we have more clarity
on what this looks like, and what people
need to be on the lookout for. Yeah, that’s beautifully said. There’s so many questions and that’s why,
in part, why we’re so worried about this. Because, you know, people
who are not going to realize and not going to have all of the facts
at hand of what you just went through, and what is that going to mean for them,
their ability to stay healthy. And I recognize a lot of people listening
are scared and worrying about what their care is going
to look like or their loved ones care. And again, there’s still a lot to be
determined and nothing happens right away. So I want to keep reiterating that point
that we have some time and we’re going to do our best
to get answers for folks once
those answers are available. But right now, no one really knows the answer,
because a lot has to be decided. And that’s where our advocates’ voices
are going to continue to be really important. So work requirements is a big bucket. That’s the big one. But there’s other things in the bill, that we care about,
like some things around Medicaid. So can you talk about kind of eligibility
verification, cost sharing, and some of the other things
that our listeners might be curious about? Sure. Yeah. I think a theme of the bill, at least when it was
when it was being debated on the Hill, on Capitol Hill,
a number of policymakers were framing the changes they were making to address
fraud, waste, and abuse. And in part, you know,
I guess trying to make an argument that people are receiving
Medicaid benefits who should not be receiving them
because they’re actually not eligible. So one of the ways that they made a change in this law is to require more frequent
eligibility verifications. These are sometimes referred
to as redetermination. Typically individuals only have to go in
and have their eligibility predetermined
once a year for the expansion population. The change now, starting in 2027,
states are going to have to conduct those eligibility determinations
twice a year. So basically the number of times you have to fill out
the paperwork will be doubled. Which, you know, definitely,
you know, there’s some concerns that will address
fraud, waste, and abuse. I think objectively,
people like us are concerned that that’s creating another hoop for people
to jump through. People move,
they change their phone numbers. They change their emails, their addresses. They don’t necessarily–the
first thing on top of their mind is I’ve gotta update my state Medicaid agency
on how to contact me. So they–it’s very likely
that people will miss, if they have to provide information,
will miss those notices, right? I think that’s absolutely legitimate. I think there’s also a population
of people who maybe have absolutely no change. They’re still living in the same place. They’re their the situation
hasn’t changed in terms of their income. It’s just whether or not, even
they will be able to do the paperwork in the right way, in the right order and
submit the right things in the right time. So it’s yes,
it impacts the population of people who, you know, might be moving, might not think
to, you know, the first thing when you’re moving, you might be thinking
to contact your state Medicaid agency. But I think even for people who, you know, might be in the same old house
doing the same old thing, it just means they have to remember to do the paperwork
twice as often as they did before. And, you know,
just what potential is that going to have for people to be,
you know, to fall through the cracks because they didn’t fill out
that paperwork? Yeah. So again, it’s
this pattern: fraud, waste and abuse. But what is really happening
is people who are eligible for Medicaid are falling through the cracks because of these additional burdens
and hoops they have to jump through. These are people that should be getting this coverage. And our fear is that they’re going
to lose their mental health care. And so again, we’re going to work
to educate the NAMI community. But it’s something that’s going to be incumbent
on all of us to share that information with our peers and loved ones
to make sure folks understand what they should be
looking for, what they should be doing. So we can try to limit
the impact of these changes. Yeah, Hannah. No, I that’s exactly right. And it does make me think too,
if someone, you know, listening to this, maybe there’s someone
listening to this who says, wait a minute. No, I think there’s a lot of fraud
in this Medicaid program. And there are a number
of really good podcasts out there that talk about what
the data tells us about fraud and who is committing fraud
within the Medicaid program. So certainly encourage folks
who are interested in that to, you know, to do some looking and learning,
because the vast majority of research is that, you know, fraud is not committed
by individuals trying to game the system. There are fraudsters. I’m not here to say that
there’s no fraud within the program, but it is typically not committed
by beneficiaries. Right. But it’s the beneficiaries who are going
to pay the price and lose the coverage, which is just tragic and really sad state
of affairs for our community. I would agree. So I know there’s lots of other Medicaid
components. And I will urge folks we are adding
updates to NAMI.org/medicaid. So that’s always going to be a hub
to find out more information. But I want to also touch
on some other pieces of this really, really large and complex bill
that are outside of Medicaid. So the Affordable Care Act did
a lot of things for mental health care. There are pieces of this bill that impact
the marketplace, the Affordable Care Act. But there’s some other things happening
outside of this bill that are changing the marketplace
for the Affordable Care, where a lot of people buy
their health insurance. Can you speak to some of those changes,
both within and outside of the bill that are going to create this more complex
environment? Yeah, yeah, absolutely. And, I think if it’s helpful, I’m
just going to say, a sentence or two, just to make sure folks are operating
on this on the same page. So the Affordable Care Act,
sometimes called Obamacare, basically, it had the idea, why don’t you expand
health care coverage to more people. And the primary we did that was expanding Medicaid,
which we’ve been talking about so far. It also created the health
insurance marketplace, which is basically for people who were not low enough income
to qualify for Medicaid, but they were individuals who were unable
to get health care insurance. Sometimes it was because their job didn’t offer health insurance,
or maybe it wasn’t affordable. Maybe they were in the gig economy
and we’re looking to purchase health insurance for themselves because they were not part
of a larger organization. So this health insurance
marketplace is a robust place for people to be able to buy health insurance. And there are advance premium tax credits that help people afford the coverage
on those health insurance marketplaces. So we’ve got the health insurance
marketplace. It’s been operating
wonderfully for the past over ten years. And there are some significant changes
that the bill makes as well as the administration did
some changes through regulation as well. And again, this theme of fraud, waste,
and abuse comes up. These changes were all kind of talked
about in the context of really wanting to address fraud
within the health insurance marketplace. But I would say that instead of going after the documented fraud in the program, it does things that impact beneficiaries. It makes it harder
for beneficiaries to get care. So just to run through some quick things,
it’s going to shorten the open enrollment period and eliminate
special enrollment periods for folks. So this is the way that people, you know, at the end of the year,
you have an open enrollment period where you can enroll in health care coverage that you’re not able
to the rest of the year. And there have been efforts
to make that longer so that more people would be able to enroll
and be aware that open enrollment exists. But I think the thought
is that, well, fraud happens if that open enrollment
period is too long. It’s going to be shortened. People are going to have less opportunity
to enroll outside of the open enrollment period by eliminating
some of these special enrollment periods that got at people who, for whatever
reason, might not have been overall during the open enrollment period
and then had a change in circumstance. It’s also going to end auto re-enrollment. The marketplace was set up to basically
try to make it easier on consumers that, you know, automatically read
enroll them in a plan if they didn’t opt for a different plan,
getting rid of that because they know about potential
that somehow is fraudulent. And even imposing a penalty
on people until they reapply. So again, a lot of changes
that are going to impact the beneficiary, but really phrased in the context of, addressing fraud, waste, and abuse. But one thing you had said, Hannah,
that I think is really important for folks to realize is,
so this is what’s been in the bill and in the regulations, but
there’s something that’s not in the bill that is estimated to have a huge impact
on these marketplaces. And that’s– while the law extended a lot of tax credits, there was one tax credit that it did
not extend, and that was the tax credit for people to buy health insurance
coverage on the marketplaces. It’s kind of the wonky name. It’s Advanced Premium Tax Credits. And they were what helped people afford
the coverage that they were able to buy. And they expire this year. They expire at the end of this year. And unfortunately,
the bill did nothing to extend them. Right. And it’s unlikely that we are going to see
any other big package get through this really partisan environment
to extend these tax credits. I think that’s certainly
the betting odds would say that. I mean, there is always the chance
that that policy makers will realize the impact of this and act
before the end of this year. But we had a huge bill pass
that was focused on tax credits and health care and these tax credits
weren’t included in that package. If Congress was going to act,
this would have been the logical place for them to act. They chose not to. And the Congressional Budget
Office, again, that kind of objective, nonpartisan scorekeeper thinks that about 5 million
people are going to become uninsured because of the lack of extension
of those tax credits, because some estimates show
that your premium could increase by about 75% on average
for those people who had tax credits and now will not have them for planned
year 2026. So, you know, I mean some people see–
double of your premium. I mean, that’s a significant chunk
of change out of your monthly budget. You know, and you see people who might
say, you know, I just I can’t afford it. I can’t afford to have this health
insurance. And, you know, 5 million people
losing coverage is quite significant. Again, the we think about 10 million
losing it, because of the Medicaid changes and about 5 million losing it because of
the premium tax credits not being expired. Yeah. So this is, I mean, this is going to cause a huge ripple effect
throughout the mental health system. I think it’s important for folks
to know that those changes to the marketplace are going to hit
sooner than the changes to Medicaid because those tax credits expire
at the end of this year. So that’s actually going to create more
of an immediate impact that states are already
trying to figure out what to do with. Because when people don’t have coverage,
their health needs don’t go away. We could face a lot more demands
on hospitals and emergency rooms where hospitals are already facing the burden
of losing a lot of their Medicaid revenue. And so it’s just kind of this
perfect storm of challenges that are going to put strain
throughout the health care system. Yeah. And it’s exactly right. And I think that’s why
we have been trying in our advocacy, and I hope that listeners, you know, will hear this
and probably many already are aware of it, that while many of the changes
impact people on Medicaid and people on the marketplace and,
you know, there might be some people out there
who think, well, I don’t have Medicaid or my loved
one doesn’t have Medicaid. So I’m not worried about this. But unfortunately,
the health care system is huge and complex and so many interconnections. You know, if your rural hospital struggles
to stay open and now has a flood of uncompensated care
because people lose access to health insurance, if that hospital chooses to close or close certain departments,
they close for everybody, not just for people with Medicaid
or marketplace coverage. So this bill has huge effects on the U.S. health care system that I don’t think
we even fully understand all of the ripples we know. We certainly know some of them, but
I think they’re going to be ripples that, that that we might not even anticipate
as a result of such a drastic change
in such a negative way. Yeah. And it’s also important
that people understand–so Medicaid’s a shared program
that the federal government pays a share, at least 50% and the state pays a share
because of a lot of these changes, states
are going to be getting less revenue, either from how they pay for Medicaid or because some of the changes
and they can’t make up the gap. And so they’re going to have to make
tough decisions. So outside of the things
Jen just talked about, they’re going to have to decide,
are they taking revenue from other places to put in the Medicaid program,
so that means cutting other services. Are they cutting eligibility or benefits
for their Medicaid program to cut costs? You know, what are the challenges
and things that they are going to have to do to have a balanced budget,
which most states are required to have? It’s really going to put enormous strain on states that are going to impact
other services whether it’s within Medicaid program
or cutting other services to make up for some of these gaps
that states have to fill in. Yeah. You and you’re so right. And that just underscores
how this is going to be so complicated because it is going to be a state–every
state is going to look different. The decisions that states make to fill in those budget
shortfalls are going to vary. And so we’re going to have to stay very diligent
not only to try to mitigate some of those negative impacts, but then also help people know
once the decisions are made, what does that mean for them
and their coverage. So this is again a Herculean task
that’s ahead of us to try to do what we can
to help our folks. Yeah. And again, I know a lot of folks
listening are scared or concerned. You know,
please know that NAMI will continue to be in this conversation
and in this fight. Again, our advocacy isn’t over, but
we also will be doing everything we can to explain what’s happening to you all
and providing whatever information we can. Jen, is there any good news we can share? Anything
positive happening in the mental health, policy space that, we can switch to? Yes. Let’s talk
about some good news here, Hannah. And I think one of the most clear good news was this July, we celebrated the third anniversary of nationwide availability of 988. I imagine that many listeners of this
podcast are very familiar with 988. But I’m wondering,
you’ve done so much work on it– Can you tell folks what is 988? Yeah, so that’s a good thing to bring up. So 988 is the National Suicide
and Crisis Lifeline. It’s something that is available 24/7,
something NAMI has advocated for many, many years
from before its inception to making sure it had the resources
to be successful. It’s a confidential, support line
for anyone in a mental health substance use or suicide crisis,
or experiencing emotional distress to call and talk
to a trained crisis counselor. We know too many people
who are in a mental health crisis have traditionally been met
with a law enforcement response. And 988 is part of our effort
to reimagine crisis response and make sure that when people are in crisis,
they have someone to talk to. And for a lot of people, that’s enough. But NAMI’s also been working
to make sure communities have additional crisis services that are focused
on providing mental health care. So it’s health care in a health care crisis, mental health
care in a mental health crisis, just like we treat other health care emergencies. And so just this month,
we celebrated the third anniversary of 998
being available nationwide. And more than 16.5 million people in the
last three years have used this resource. So, you know, NAMI is really proud of
our advocacy around making 988 available. We know there’s a lot more work to do. This is never a short term effort
to build out this crisis system. And we know that 998 provides
what is needed for a lot of people. And yet some people still have
challenging experiences, so we won’t rest until everyone has all of the care
and support they need in their crisis. But we have come so far
in the last three years. And, you know,
it was really exciting to celebrate that. And actually, NAMI released new polling. We’ve been tracking
what people know about 988 and more than three quarters of Americans
are least, aware of 988. So they’ve heard about it. A lot less actually know what it is,
so we have some work to do. And I encourage everyone
that’s listening to share 988 with at least,
you know, five people in your life. Make sure that they know about it. I know it’s always gratifying for me
when I meet somebody new and can tell them about 988
but that is something positive going on that 988 is available
and it’s helping people and continues to grow and provide
more and more resources. If there is one positive thing for us to focus on this month,
it is absolutely that. It is such an amazing accomplishment and
something that has helped so many people. Well, you know,
we always wrap up every episode asking the question, what gives you hope? You know, this is really about making a place that people can find hope
and hold on to that hope. So, Jen, I’ve worked with you a long time. But I’m curious, you know, what helps
you hold on to hope? Gosh, that is a great question,
because there– I’ll be honest, there have been times over the past
few weeks where it’s been hard to hold on to hope,
you know, to be quite honest, you know, to see this legislation
passed that many knew we’re going to hurt
lots of people. But undeniably,
what makes me hold on to hope is the NAMI community
and how much the NAMI community rallied to tell their policymakers
that this was a bad idea. And as we talked about at the beginning,
that the cuts were not as bad as we anticipated they might be, it’s
not to say they’re not going to be really damaging, but they are not–
this is not as bad as it could have been. And that’s
because 172,000 people took actions to call their member of Congress, to write
a letter, to click through our alerts, and to have that outpouring of support
from individuals. It is impossible
not to have hope hearing those numbers and hearing the impact
that we were able to have. I couldn’t agree more.
What a beautiful way to end. Our NAMI advocates are the best. And thank you, Jen, for joining us today. You know,
it is an honor for me to work with Jen. She is truly a policy expert
and a relentless advocate for the NAMI community. So I’m so glad that she could be
on the podcast with us today. This has been Hope Starts With Us, a podcast by NAMI,
the National Alliance on Mental Illness. If you’re looking for mental health
resources, you are not alone. To connect with the NAMI helpline and find
local resources, visit NAMI.org/help, text “helpline” to 62640 or dial 800-950-NAMI. That’s 800-950-6264. Okay, if you’re in experiencing
an immediate suicide, substance use, or mental health crisis,
we just talked about 988, so please call or text 988. You can also chat on 988lifeline.org. You’ll speak to a trained crisis specialist who can help you
and provide you the support you need. I’m Hannah Wesolowski
your guest host today. Thanks for listening. And be well.

In this follow-up conversation about Medicaid and mental health advocacy, NAMI’s Chief Advocacy Officer Hannah Wesolowski discusses Medicaid cuts and advocacy opportunities with Jennifer Snow, NAMI’s National Director of Government Relations and Policy. Listeners will hear their expert opinions on how Medicaid cuts just passed by Congress will impact people with mental health conditions and their families, policies NAMI will be monitoring, how supporters can stay involved, and more. Plus, hear from Hannah and Jen about the third anniversary of the 988 Suicide and Crisis Lifeline and NAMI’s recent public opinion polling about 988.
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If you or a loved one is seeking mental health treatment or additional information on mental health:
• Visit our website at NAMI.org.
• Call our HelpLine at 1-800-950-NAMI (6264) or text “HELPLINE” to 62640, open Mon-Fri from 10 a.m. to 10 p.m.
• Find your local NAMI at nami.org/findsupport
• If you or a loved one is experiencing a crisis, please call or text 988, available 24/7
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NAMI, the National Alliance on Mental Illness, is the nation’s largest grassroots mental health organization dedicated to building better lives for the millions of Americans affected by mental illness.