OUR OPINION: Change mental health Medicaid pay formula

By NEMS Daily Journal

Mississippi’s 15 community-based mental health centers, which serve regions as much as individual towns, have been gasping for adequate funding, but a possible federal lawsuit related to how the state pays and does not pay for the services could work in the centers’ favor.
Mississippi as a matter of law and policy does not pay Medicaid reimbursement for eligible patients in the system, yet it pays private-sector health care providers for Medicaid charges of eligible patients.
Mississippi is one among 27 states in which the Department of Justice has either filed lawsuits or is investigating inequities in the kind of mental health care provided by the state.
A year ago this week, Georgia agreed to settlement of a lawsuit brought by the Department of Justice alleging illegal segregation of some mentally disabled patients in inadequate or inappropriate settings.
The settlement, among other orders, required Medicaid waivers to pay for at least 1,000 patients to have community-based care.
The Atlanta Business Journal reported:
“Under the agreement, over the next five years, Georgia will increase its assertive community treatment, intensive case management, case management, supported housing, and supported employment programs to serve 9,000 people with mental illness in community settings; increase community crisis services to respond to and serve people in a mental health crisis without admission to a state hospital; create at least 1,000 Medicaid waivers to transition all people with developmental disabilities from the state hospitals to community settings …”
Georgia’s situation is not exactly like Mississippi’s issues, but it is similar.
Medicaid is a federal-state program that helps low-income individuals or families pay for the costs associated with long-term medical and custodial care, provided they qualify under a formula based on income. Although largely funded by the federal government (Mississippi gets the largest drawdown match by percentage of costs among all the states), Medicaid is run by the states, and coverage may vary.
As it stands, community mental health centers like Region 3 in Tupelo, Communicare in Oxford and Timberhills in Corinth, have to raise half the money needed to receive a full federal match.
The Department of Mental Health has been paying half the matching costs but is seeking a full $20 million in 2012. The total Medicaid share of community-based mental health is $80 million.
As it stands, it appears Mississippi has two choices: voluntarily pay or be forced to pay by a federal decree.
Placing people in community-based care when recommended is cheaper than hospitalization and makes medical and financial sense.