By Vincent Atchity, Colorado Politics
Director of Mental Health Colorado urges legislators to eliminate the 15-day treatment cap for Medicaid patients with serious mental illness
Many are aware Colorado is in a dire crisis of mental health, substance misuse and homelessness. We see every day too many of our friends, family members and neighbors are experiencing difficulties. We see we don’t have the proper supports and safeguards in place to stop people from experiencing preventable worst outcomes. However, most are unaware of the outdated and seemingly benign policies that perpetuate this vicious cycle.
We’re constantly seeing tragic stories play out in our communities. A person falls on hard times, experiences mental distress or substance misuse or all of the above. Their health needs go unmet and before they know it, they’re cycling through jails, ERs, homeless encampments and various kinds of crisis centers. With some luck, they may find themselves in the hands of competent mental health providers in a quality in-patient setting, but even in those rare cases, they're often forced out before they have the chance to stabilize and get back on their feet.
That’s due to a decades-old rule — one Colorado lawmakers are currently reconsidering — preventing mental health hospitals from being reimbursed for Medicaid patients in their care for longer than 15 days (. Enacted in 1965, the rule was part of a larger effort intended to create community-based capacity for mental healthcare in the least restrictive settings and prevent unnecessary institutionalization. Today — because that dreamed-of capacity was never developed — this policy leads to the discharging of vulnerable and unstable patients from supportive in-patient settings before they have gotten all the care they need and, often, before they have a place to go. As a result, we’re spending efforts and resources, over and over again across systems, and failing to meet the needs of seriously ill patients.
A recently released report from the Treatment Advocacy Center perfectly sums up the result and the disordered array of policies that perpetuate it. Colorado now has the third-longest waitlist in the country for people who are waiting in jail for access to a mental health treatment center after being found incompetent to face low-level criminal charges. Incarcerating people who are presumed innocent when they are known to have unmet health needs is an unacceptable tragedy, a violation of their rights and a disgrace to our society.
Though there are several factors in play here — over-incarceration of those with mental illness being a glaring one — expediting Medicaid patients’ access to stabilizing care in Colorado’s mental health hospitals is a key step we must take to disrupt this vicious cycle. Colorado lawmakers need to act now to extend Medicaid coverage for mental healthcare and give these vulnerable Coloradans a real shot at healthier, more productive lives. Lifting the 15-day cap on Medicaid coverage for in-patient care will enable providers to support improved health outcomes.
Research from other states that have already lifted the 15-day cap shows promising results. For one, by providing institutional care for the most acute patients, states have freed up resources for community-based services for others with less intense needs. These states also have seen a decline in emergency department use after patients were discharged more responsibly from psychiatric care, saving critical resources.
Plus, hospital readmission rates decreased. Hospital readmissions have been a major contributor to the capacity issues we’re facing in treatment centers: between January 2020 and July 2023, 3,171 patients were admitted and readmitted to a Colorado mental health hospital, according to data from UHS hospitals.
If the state invests now to provide adequate mental healthcare to those with serious mental illness, we will diminish the hemorrhaging of resources elsewhere, including in ERs, jails, crisis response and local responses to homeless encampments. This investment will meaningfully underscore our state’s commitment to addressing this dire crisis that's tearing families apart and claiming lives. It’s time to bring our Medicaid policies into the 21st century and disrupt this deadly cycle.
Read the original article here.
Vincent Atchity is president and chief executive of Mental Health Colorado. He's a public health and health equity advocate and has worked as a leader of the Equitas Project to disentangle mental health and criminal justice and promote care not cuffs. He has served on the Governor Polis' Behavioral Health Task Force and Behavioral Health Transformational (ARPA) Task Force.
