Proposal expands Medicaid coverage for mental health and substance use disorder treatment

WASHINGTON — As cities from coast to coast grapple with addiction and homelessness, there is now a push in Congress to expand access to mental health treatment for low-income people.

“We hear from families everyday who have a loved one who’s in a mental health crisis and there’s no bed available,” said Hannah Wesolowski, Chief Advocacy Officer for the National Alliance on Mental Illness (NAMI). “There’s no place for them to get in-patient care.”

That’s in large part because of a 1965 law that banned federal money from paying for mental health treatment in a hospital with more than 16 beds.

“It came about as a way to move from institutionalization, which is a really important thing,” said Wesolowski. “It had this contrary effect of really limiting the ability of people to access the care they need when they need it.”

Mental health advocates say those unintended consequences left many people on the streets or in jail.

“If somebody is in crisis, they go to an emergency room. There’s no bed available. Often, they’re discharged back on to the street. How is that helping the person and how is that improving the community?” said Wesolowski.

Last month, the House overwhelmingly passed a measure to change the nearly 60-year-old rule.

Provisions in the Support for Patients and Communities Reauthorization Act would require Medicaid to cover medication-assisted treatments and it gives states the option to cover substance use disorder treatment in a mental health facility for up to 30 days over a 12-month period.

A similar measure is being considered in the Senate.

Some critics have cautioned the focus should instead be on investing more in community-based resources.

Supporters, meanwhile, argue it’s a change that is long overdue.

“It’s the only piece of Medicaid law that restricts the type of care based on a person’s illness,” said Wesolowski.

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