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Medicaid ruling costly to state’s mentally ill

Now that the Obamacare registration period is over, and as soon as Kathleen Sebelius’ replacement is in office, perhaps the nation can get serious about rectifying the most egregious failure of the Affordable Care Act. That, of course, is the fact that 24 states, including Indiana, have declined to participate in an expansion of Medicaid that would cover millions of Americans who are above the poverty level but make too little money to qualify for tax credits for exchange-purchased insurance. This archipelago of forgotten Americans may include as many as 400,000 Hoosiers.

A recent report by the American Mental Health Counselors Association focuses on one aspect of this shameful situation. The AMHCA estimates that 3.7 million Americans with serious mental illness, psychological distress or substance abuse are among those left out in the cold in the 24 states that aren’t participating in Medicaid expansion.

In Indiana, the association estimates, 247,000 people who fall into the Medicaid/exchange gap suffer from one of those three disorders. Though larger states, as one might expect, show higher numbers in the AMHCA’s report, “Of the states that didn’t expand, Indiana has the highest percentage of adults with mental health conditions among those who would have been Medicaid-eligible – 62 percent.”

“That seems a little high to me,” said Matt Brooks, CEO of the Indiana Council of Community Mental Health Centers, Inc., who had not seen the report. The focus, he said, ought to be on those who have serious mental problems, who represent about 6 percent of the population and need consistent access to treatment, medication and sometimes crisis intervention.

“Approximately 24,000 suffering from serious mental illness are not eligible for the Medicaid program due to their income level,” he said. That’s the size of a small city.

The Healthy Indiana Plan, which Gov. Mike Pence wants to use as a model for any expansion of state health coverage, does not cover comprehensive mental health care, Brooks said. His organization is among those trying to ensure that the state includes adequate mental health provisions in any expansion plans. Such plans need to put mental health treatment on the same plane as treatment for physical illnesses – something Brooks said may not even be the case with the new exchange insurance plans. “There are still a lot of unknowns,” he said.

This state pays a price when some of its citizens are left without health care, but there’s a special toll on society when the mentally ill are shut out. The numbers may remain in dispute, but it’s beyond argument that Indiana must move forward with a plan to provide for its citizens who fall into the Medicaid/exchange gap.