NMHA Legislative Alert
July 29, 2005

 
Pressure Congress to Protect Medicaid Beneficiaries
Urge Senators and Representatives to Oppose Harmful Proposals

This September, Congress will act on legislation to reduce federal spending on Medicaid. Medicaid plays a key role in funding mental health services. While your members of Congress are home for the August recess, it is critical that you push them to oppose any changes to Medicaid that will harm the vulnerable people who need support from this vital program.

The National Governors Association (NGA) has recommended that Congress consider a number of changes to Medicaid that could harm beneficiaries including:
Increasing cost-sharing (i.e., premiums, deductibles, and copayments);
Reducing benefits to those offered by the State Children´s Health Insurance Program;
Limiting federal oversight of the Medicaid waiver process; and
Restricting judicial enforcement of consent decrees to protect beneficiaries´ rights.


Action Critically Needed during August:

Call and e-mail your members of Congress;
Meet with them and/or their staff in their local offices; and
Speak up at public events being held by members of Congress.

Talking Points:

DO NO HARM to Medicaid beneficiaries!
Increasing co-payments will harm the low-income people who need Medicaid, particularly those with mental illness because of their intensive healthcare needs.
Reducing Medicaid benefits to SCHIP coverage will decrease access to critical mental health services. Medicaid benefits are already appropriately limited by medical necessity requirements.
Find the savings called for by the budget resolution in other federal programs. Medicaid is a key source of support for public mental health services that are already severely under-funded.
Preserve federal protections for Medicaid beneficiaries by -
upholding federal waiver requirements and requiring more public input; and
maintaining enforcement of judicial consent decrees to protect beneficiaries´ rights under Medicaid.

If you have any questions, contact Kirsten Beronio at kberonio@nmha.org or 202-675-8413.

How to Contact Your Members of Congress

Call: To contact your members´ local offices, visit their Web sites at www.senate.gov or www.house.gov to find locations, phone numbers, and fax numbers; or

Call your member´s Washington DC office, by telephoning the U.S Capitol Switchboard at 202-224-3121 and asking to be connected to your Representative´s or Senator´s office.

E-mail:
Go to the Internet site http://www.congress.org
Enter your ZIP code
Select the appropriate Member of Congress
Click on the e-mail address and a message form will appear that you can fill out (by cutting and pasting the talking points above) Fax: Call the office of your member of Congress to request the fax number or visit his or her Web site, where a fax number is usually listed. Background

Congress passed a budget resolution this spring that includes a $10 billion cut that is expected to come primarily out of federal funding for Medicaid. Shortly thereafter, the National Governors Association (NGA) released a set of Medicaid reform proposals that members of Congress are considering as they develop legislation to find the savings called for in the budget resolution. The NGA has proposed several troubling Medicaid changes that will surely be enacted unless members of Congress hear opposing views from their constituents this summer.

NGA Proposals

Increasing Cost-sharing

The NGA has urged Congress to give states broad discretion to dramatically increase cost-sharing - i.e., the amount people must pay out of their own pockets in premiums, co-payments, and deductibles to receive services through Medicaid. Research has shown that increased cost-sharing for low-income people causes them to reduce use of medications and medical care resulting in more serious conditions and increased need for emergency care.1 These consequences are especially troubling for people with mental illness and other chronic conditions who, in general, need more medical care and medications.

Moreover, people with mental illnesses have high rates of co-occurring disorders. For example, those with schizophrenia also often need treatment for diabetes, hypertension, cardiovascular disease, substance abuse, obesity or rapid weight gain, hepatitis C, and HIV. Co-payments for these individuals who need multiple medications can quickly add up to make treatment unaffordable. Federal proposals to encourage increased copayment requirements by the states endanger these individuals in need of complex medication regimens.

Reducing Benefits

NGA has also urged Congress to repeal federal assurances that Medicaid beneficiaries will have access to certain necessary health care services. The Governors state that the State Children´s Health Insurance Program (SCHIP) is a good model for how they would revise the benefits offered by Medicaid. However, SCHIP or any benefit package based on private insurance coverage is not an appropriate substitute for the Medicaid population. According to the General Accounting Office, states have used the private plan option under SCHIP to significantly restrict mental health benefits and appropriate treatment, typically limiting coverage of both inpatient care (to 30 days) and outpatient care (to 20 visits per year).2 Moreover, SCHIP plans often do not include benefits such as intensive rehabilitation services, in-home care, and day treatment that are so critical to many children with serious emotional problems. Without Medicaid coverage, these critical services will be inaccessible for most low-income children and adults.

Furthermore, SCHIP plans do not include the vitally important Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) benefit provided to children through Medicaid. EPSDT requires that treatment be furnished to children on Medicaid to correct or ameliorate physical and mental illness and conditions discovered by regularly scheduled screenings. Without this benefit, low-income families of children with mental health disorders would be unable to afford the psychiatric care their children need to progress in school and grow up to be healthy adults.

In addition, although the Governors claim that Medicaid benefits must be more targeted to take into account the needs of different subpopulations of beneficiaries, this is misleading. Medicaid benefits are already appropriately targeted by the medical necessity requirement that ensures that individuals do not receive medical services that they do not need.

Limiting Federal Oversight

In addition, NGA urges that Congress give states broad authority to waive federal requirements and consumer protections without federal oversight. But, the federal government pays for over half of Medicaid funding and has a responsibility to track and monitor how these funds are used. If anything, the process whereby waivers are developed and adopted should be improved to ensure more public input. Currently, these waiver proposals are generally discussed and finalized behind closed doors without adequate notice and opportunity for public comment.

Restricting Judicial Enforcement

The NGA also wants Congress to limit Medicaid beneficiaries´ access to courts to enforce their legal rights by restricting the applicability of judicial "consent" decrees. This proposal would undermine an important means of ensuring that states comply with Medicaid protections for some of our most vulnerable citizens.


1Ku, Leighton, The Effect of Increased Cost-sharing in Medicaid: A Summary of Research Findings, Center on Budget and Policy Priorities, May 31, 2005.
2General Accounting Office. April 2000. Medicaid and SCHIP: Comparisons of Outreach, Enrollment Practices and Benefits.

 

Marge Parrish
Special Projects Coordinator
Mental Health Association
314/773-1399