Johnny Olszewski Joins 111 County Executives In Calling For More Federal Help On Mental Health Services

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Credit: Van Fisher/Patch

BALTIMORE COUNTY - The National Association of Counties (NACo) has penned a letter to Congress on behalf of elected officials representing 30 states and 111 counties across America.

Counties are integral to the nation's behavioral health system, both funding and coordinating behavioral health services, including those provided in county-owned and operated community health facilities.

In their letter, county executives call for the federal government to provide more funding for mental health services and expand the qualifications needed to receive funding.

"Congress still has an opportunity to pass additional behavioral health policies that would improve the lives of millions of Americans before the end of the year."

NACo is explicitly asking the federal government to do five things:

Amend the Medicaid Inmate Exclusion Policy (MIEP).

The Medicaid Inmate Exclusion Policy (MIEP) is a federal statute that prohibits using federal funds and services such as Medicaid for "inmates of a public institution." This policy was described as "unfair and harmful" in the NACo's letter and has served to deny inmates critical care.

Many inmates across the country suffer from opioid use disorder and require Medicaid funds for treatment and medication. According to the Substance Abuse and Mental Services Administration, nearly 12% of Medicaid beneficiaries over 18 have a substance abuse disorder.

SUD is heavily concentrated in county jails, with a staggering 63 percent of jail inmates suffering from a substance abuse condition, including OUD. However, the National Academy of Sciences reports that only 5 percent of people with an OUD receive medication treatment in jail and prison.

The counties voiced support for four bills that would amend MIEP to allow for greater access to addiction treatment and mental health services.

  • The Medicaid Reentry Act (H.R. 955/S.285): Would allow Medicaid payment for medical services furnished to an incarcerated individual during the 30 days preceding the individual's release.
  • The Due Process Continuity of Care Act (S.2697): Would allow pretrial detainees to receive Medicaid benefits at the state's discretion.
  • The Equity in Pretrial Health Coverage Act (S.3050): Would remove limitations under Medicaid, Medicare, CHIP, and the Department of Veterans Affairs on benefits for a person in custody pending disposition of charges.

Repeal the institutions for mental disease (IMD) exclusion.

Institutions for mental diseases (IMDs) are classified as any psychiatric treatment facility with more than 16 beds. The current federal Medicaid statute prohibits federal reimbursement for care provided by IMDs.

This IMD exclusion has created significant barriers for counties seeking inpatient mental health services, especially for adults with serious mental illness (SMI) and children with serious emotional disturbance (SED).

According to NACo, "Easing the Medicaid IMD exclusion has been a longstanding behavioral health priority for counties, as it can expand the treatment capacity of county-operated hospitals and behavioral health authorities."

NACo recommends that Congress permanently amend the IMD exclusion to permit Medicaid to cover care for needed inpatient behavioral health treatment to all Medicaid beneficiaries and repeal the arbitrary 16-bed limit.

"These actions would greatly increase equitable access to mental health care treatment options and services in local communities," Naco wrote in its letter.

Fund direct and flexible grant programs to counties to support the recruitment, training, and retention of a sufficient behavioral health workforce.

Counties are asking the federal government to provide more funding for programs and initiatives that assist with and incentivize the recruitment, training, and placement of behavioral health providers that will work within local communities.

According to data from the Robert Wood Johnson Foundation, 30 percent of the nation's population lives in a county designated as a mental health professional shortage area. The U.S. Department of Health and Human Services (HHS) expects this number to grow over the next decade as the number of providers nationwide is projected to decrease by 20 percent, while demand is anticipated to increase rapidly. Maryland specifically is 101 health professionals short of no longer being listed as a Health Professional Shortage Area.

Sustain federal funding to support local crisis response infrastructure through Medicaid.

Counties are asking the federal government to do more to modernize crisis response infrastructure, including support for the 988 national suicide prevention lifeline and related services.

Naco's letter notes that The American Rescue Plan Act provided a 3-year enhanced federal matching rate under Medicaid for states to expand access to mobile crisis intervention services.

Counties want this rate to continue so that fewer mentally ill residents end up in hospitals or jails.

"Crisis response services also reduce the fiscal burden of behavioral health crises faced by counties by minimizing emergency department visits and hospitalizations and contributing to lower rates of arrest and incarceration of people with behavioral health conditions, who are disproportionately represented in local jails," NACo said.

Enforce policies that ensure equal coverage of treatment for mental illness and addiction.

In 2008, Congress passed the Mental Health Parity and Addiction Equity Act (MHPAEA), which required comprehensive standards for equitable coverage of mental health and substance use disorder treatment and medical/surgical treatment coverage.

There are still forms of insurance such as Medicare, specific state Medicaid programs, Veterans Administration, or short-term limited duration health plans that still limit mental health coverage. Additionally, federal laws do not require parity in reimbursement rates, and consequently, Americans face barriers to access as people cannot find in-network mental health care providers.

Counties are calling for these forms of insurance to remove their limitations on mental health coverage and improve equity for all Americans.

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