Thursday, December 2, 2010

What Does the Election of New Governors Mean for Mental Health Advocates?

By Sita Diehl, NAMI's Director of State Policy and Advocacy

Sita Diehl, Director of State Policy and Advocacy
They may have been elected in different states this November, but America’s 27 new governors—17 Republicans, nine Democrats and one Independent—will take office in January in the same daunting political environment. Most will appoint new directors for Medicaid, state mental health authorities and insurance commissions who will be in a position to dramatically influence our nation’s mental health care system, a system that the NAMI Grading the States 2009 report gave a “D” grade. These state government administrative leaders will face a steep learning curve as the economy continues to sputter and implementation of the Patient Protection and Affordable Care Act (ACA), otherwise known as the health reform bill, moves to the states.

Conserving Scarce Resources, Looking To More Prosperous Times

Despite improvements in the economy, last year was tough for state governments and next year will be even tougher for state budgets. In 2011, state budgets nationwide closed with $100 billion in shortfalls. In 2012 states are projecting a total deficit of $140 billion with enhanced federal Medicaid funds expiring June 30, 2011. Unemployment is part of the issue. For every one percent increase in the unemployment rate state revenues fall over three percent, just as more people enroll in Medicaid or join the ranks of the uninsured.

Governors will make key decisions over the next few months about how to conserve scarce resources while simultaneously preparing for the promise of more prosperous times. Some governors will examine what government should be doing versus the private sector and will be looking for ways to become more efficient so they may invest scarce dollars in direct care. Contracting with nonprofit organizations and businesses is one method for states to shift toward non-governmental jobs to deliver efficient, effective care.

Unfortunately, many mental health systems are already at the point of collapse, due in part to steep budget cuts over the past two years without a corresponding investment in community services. As mentioned earlier, on average, state mental health care systems get only a “D” grade in part because of a lack of adequate investment in community services. And this grade was in 2009—predating some of the worst fallout from the economic crisis. Reducing state government investment even further may precipitate a complete mental health care system failure.

Health Care Reform: Roots on the Democrat and Republican Sides of the Fence

Some governors will move forward to implement the ACA, planning for state insurance exchanges and expansion of Medicaid to cover uninsured residents with incomes at or below 133 percent of the poverty level. Despite widespread distrust of the law as a whole, the ACA has roots on both the Democrat and Republican sides of the fence. Republican principles of reduced government and personal responsibility are embodied in private insurance exchanges and small business coverage. Democratic values of a just and equitable society are represented in insurance industry reforms and coverage of the uninsured through Medicaid expansion. Mental health parity, incorporated throughout the law, has long standing bipartisan support.

What else can mental health advocates do to help save mental health?
  1. Familiarize yourself with talking points and personalize them to your comfort.
  2. Contact and congratulate your new Governor in a letter introducing yourself and mentioning your support of mental health.
  3. Inform him/her that mental illness is common and treatable.
  4. Urge the governor to preserve the mental health budget from further erosion.
  5. Urge Medicaid directors to apply for a Medicaid1915i option to provide mental health services such as peer support not traditionally funded by Medicaid.
  6. Monitor parity in public and private health care; contact NAMI if you or someone you care about is denied equal coverage for mental health care.
Most governors, regardless of party affiliation, will take a hard look at Medicaid as a strategy to bring the budget into line. Because the ACA prohibits states from excluding categories of Medicaid beneficiaries, state governments are considering alternative cost control measures such as managed care, service and pharmacy limits or even opting out of Medicaid altogether.

Mental Health Advocates Must Stand Firm in 2011

Mental health advocates must urge governors to preserve mental health benefits in Medicaid and encourage the development of a plan for 2014 when, as insurance exchanges begin, people with mental illness will be able to join the workforce without losing health care coverage.

In states across the country, this is a time of economic retrenchment, but it is also a time to plan for a more prosperous future. The smart choice is to invest in supporting mental health systems that deliver the right care at the right time and in the right place so children and adults living with mental illness can succeed and contribute to their family, workplace, school and community.



Sita Diehl, M.A., M.S.S.W., is NAMI's director of State Policy and Advocacy. She served as executive director of NAMI Tennessee from 2004 to 2010. She has developed a range of mental health curricula for individuals living with mental illness, families, mental health care providers and criminal justice personnel. Her research experience includes a two state comparison of the effect of public managed behavioral health care on women and children, a multi-site study of consumer-operated services and a longitudinal study of mental health services in Tennessee county jails.

1 comment:

Jkent said...

An extremely poignant article, Sita drives home the message that if we want to see positive changes--financially and in societal/governmental perspectives--we must be those agents of change--"advocates". Sita states, "Unfortunately, many mental health systems are already at the point of collapse, due in part to steep budget cuts over the past two years..." And although this is true, we must take the responsibility for those cuts as we allowed officials we elected to make such sweeping changes within the mental health system, causing near collapse.

Thank you, Sita, for an article that got my attention enough to work harder at fighting the various levels of mental health stigma and fighting for the monies--given so easily to the physical health of our citizens, yet it is like "pulling teeth" to see those same behaviors in mental health.

J. Kent Usry, LCSW
Memphis, TN