Mental Health Medicaid Rule Makes Sense, Unlike ACA

Published May 3, 2017

May is “Mental Health Month,” and relief for certain Medicaid patients with mental illness is around the corner as a new rule by the Centers for Medicare and Medicaid Services (CMS) takes effect on July 1. The rule change will render patients on Medicaid managed care plans eligible for up to 15 days of inpatient hospital mental health care.

In contrast to the divisive Medicaid expansion under the Affordable Care Act (ACA), the CMS rule change has received little attention. In further contrast, the change is an expansion of Medicaid services free-marketers are unlikely to oppose. This is because ensuring mental health care access for needy patients disabled by mental illness makes sense.

By comparison, expanding Medicaid under ACA to cover able-bodied individuals without requiring them to work for the entitlement makes no sense. Worse, Obamacare Medicaid expansion programs divert state and federal tax dollars away from the truly needy, including low-income Medicaid patients will debilitating mental illness.

Poor patients with crippling mental illness occupy a category conservatives and libertarians generally agree warrants a taxpayer-funded safety net. (To learn more about this category, I recommend Peter Ferrara’s brief and readable Power to the People: The New Road to Freedom and Prosperity for the Poor, Seniors, and Those Most in Need of the World’s Best Health Care, published by the free-market think tank The Heartland Institute, which also publishes Consumer Power Report, in 2015).

Free-market-minded psychiatrists support the new CMS rule’s expansion of mental health care services for Medicaid patients with debilitating mental illness.

Dr. Robert Emmons, a psychiatrist in private practice in Burlington, Vermont, recently told , “Medicaid beneficiaries do sometimes need very long hospital stays. I have to admit that it is Health Care News hard for even a free-market guy like me to imagine how that kind of treatment gets paid for without a taxpayer-funded program.”

Heartland Policy Advisor Dr. Kathy Platoni, a clinical psychologist and retired U.S. Army colonel in Centerville, Ohio, specializes in treating post-traumatic stress disorder. Regarding the CMS rule, Platoni told Health Care News, “My disabled patients on Medicaid are too often the last to have access to medically and psychologically necessary treatment. This appears to be one of the most viable solutions available and one that I’m thrilled to know is on its way.”

The CMS rule will affect patients in the 39 states that pay managed care organizations (MCOs) to provide enrollees comprehensive health care. In 28 states, three-fourths of Medicaid enrollees receive services from MCOs, the Kaiser Family Foundation reported in April. The rule change updates thinking dating to the 1970s, when regulators feared MCOs would lock up mentally ill Medicaid patients in de facto insane asylums, according to The Columbus Dispatch.

With asylums no longer a threat, allowing mentally ill Medicaid MCO patients a 15-day inpatient stay at an institution for mental diseases is consistent with the principle, shared by most free-marketers, that it is acceptable for taxpayers to fund a temporary (in most cases) safety net for society’s genuinely needy and most vulnerable people who have no recourse.

The same cannot be said for the population roped into the Medicaid system when 31 states and the District of Columbia expanded their programs under ACA.

Obamacare Medicaid expansion awards taxpayer-funded health insurance to able-bodied people earning up to 138 percent of the federal poverty level, or $16,643 for an individual and $33,948 for a family of four. Under President Barack Obama, CMS repeatedly denied states the right to require Medicaid expansion recipients to work for the new entitlement.

Expanding this entitlement to able-bodied individuals diverts tax dollars away from the truly needy. For example, in Illinois, 752 Medicaid patients on the state’s waiting list died awaiting needed care in the first 3.5 years following the legislature’s adoption of Medicaid expansion. In addition, more than 18,000 individuals have submitted urgent needs for additional Medicaid services, Nic Horton, a senior research fellow at the Foundation for Government Accountability, reported in December 2016. Arkansas is home to similar injustices.

People favorably disposed to Medicaid expansion under Obamacare will no doubt brandish incidents of mentally ill patients gaining access to mental health care through Medicaid expansion. Fine; they miss the point.

The real question is whether it is sound policy to continue granting able-bodied individuals not required to work – the Obamacare Medicaid expansion population – a health insurance entitlement equal to that of even lower-income patients with debilitating mental illness. The sane answer is no.

– Michael T. Hamilton ([email protected], @MikeFreeMarket) is a Heartland Institute research fellow and managing editor of Health Care News, author of the weekly Consumer Power Report, and host of the Health Care News Podcast.



She isn’t who U.S. Rep. Tim Murphy had in mind when he crafted a new law creating the position of assistant secretary for mental health and substance abuse.

Elinore F. McCance-Katz of Rhode Island has been nominated for the job, which puts her in charge of the Substance Abuse and Mental Health Services Administration, an agency she worked for during a contentious period that fueled Mr. Murphy’s reform efforts.

In an unusual break with Donald Trump, the Upper St. Clair Republican slammed the president’s pick.

“I am stunned the president put forth a nominee who served in a key post at SAMHSA under the previous administration when the agency was actively opposing the transformative changes in” the congressman’s mental-health reform bill, which ultimately passed, he wrote in a statement Monday. “The old regime at SAMHSA was incapable and unwilling to work with me and my colleagues in Congress to deliver the transformative changes needed.” …

Besides creating the new assistant secretary position, the law expands Medicaid patients’ access to in-patient psychiatric care, ties program grants to measurable outcomes, and makes it easier for caregivers to access treatment plans of patients with severe mental illnesses that impair their ability to make decisions about the own care.

SAMHSA fought the legislation when Dr. McCance-Katz was chief medical officer from 2013 to 2015. She now is chief medical officer for Rhode Island’s behavioral health department.

“She was the key medical leader when the agency actively lobbied against any change or accountability including when the Energy and Commerce Committee – indeed the entire Congress – was aiming to fix our nation’s broken mental health system,” Mr. Murphy wrote in a scathing statement Monday. …

SOURCE: Tracie Mauriello, Pittsburgh Post-Gazette


House Republican leaders are on the brink of losing too many GOP votes to pass their health-care bill overturning much of the Affordable Care Act, potentially dashing hopes raised by the White House of a big legislative win this week.

At least 21 House Republicans have now said they oppose the latest version of the Republican plan to overhaul the health-care system, with an almost equal number publicly undecided on the bill. House GOP leaders can likely lose only 22 GOP votes to pass the bill, because it isn’t expected to receive any Democratic support. …

The president, vice president and top aides had said they were confident about closing in on the votes for a health-care bill soon.

Tuesday morning, Rep. Fred Upton (R., Mich.), a former House Energy and Commerce Committee chairman who is widely respected among House Republicans, told a Michigan radio station he couldn’t support the bill in its current form.

“There are a good number of us that have raised real red flags and concerns,” Mr. Upton said. “It’s not going to get my ‘yes’ vote the way that it is.” …

On Monday, Rep. Billy Long, a Missouri Republican who doesn’t often break ranks with GOP leaders, also said he couldn’t support the bill. …

The House Freedom Caucus, a group of about three dozen conservatives, endorsed the bill last week after balking at its earlier version, and any new changes could prompt them to flee. …

SOURCE: Kristina Peterson and Stephanie Armour, The Wall Street Journal


Dental therapy is nearing a tipping point in the United States, whether “Big Dentistry” likes it or not. That’s according to Kristin Mizzi Angelone, a dental policy expert with the Pew Charitable Trusts. …

Like nurse practitioners and physician assistants are to doctors, dental therapists are mid-level providers who can perform many of the same procedures as dentists, such as pulling teeth and filling cavities. And as with the medical profession, dental therapy has run into opposition from the profession’s top dental groups that continue rifling through an excuse rolodex to protect their turf. …

The American Dental Association (ADA) reported in 2015 that dental ER visits doubled from 1.1 million in 2000 to 2.2 million in 2012, or one visit every 15 seconds.

Yet the ADA and its state affiliates have consistently fought efforts in states to authorize dental therapy as a viable option for the underserved, despite success in at least 54 countries since 1921. …

During debate last year, a Vermont lawmaker read a letter from the Vermont Dental Society:

“We are convinced that this proposal, if enacted, will eventually create a two-tier system of dental care in Vermont with some patients seeing a dental therapist and others seeing a dentist.”

Michael Hamilton calls this excuse bunk. A senior research fellow in health care policy at the free-market Heartland Institute and co-author of “The case for licensing dental therapists in North Dakota,” Hamilton has testified in support of dental therapy before a number of state legislatures, most recently in Connecticut.

“The truth, however, is Connecticut already has a two-tiered system – a system of ‘haves’ and ‘have nots.’ Blocking dental therapy would preserve Connecticut’s two-tiered system,” he said in February.

Hamilton tells that the dental lobby is running out of reasons to oppose dental therapy, and predicts the tide will turn when dentists finally embrace the profession as a way to broaden their own opportunities.

“Because the only thing licensing dental therapists would do, is expand dentists’ own liberty to run their practices however they want to as small business owners, and treat patients according to their own professional judgement,” he said.

“Allowing therapists to practice increases the freedom of dentists to hire, train, and delegate according to each dentist’s professional judgment.”

Mizzi adds that 30 years ago, the idea of going to anyone other than a doctor for their routine health needs was unthinkable.

“But nurse practitioners and physician assistants have changed that dynamic in one generation. The parallels between that movement and dental therapy are obvious. It will take time, but dental therapists will become as common as nurse practitioners.”

SOURCE: Kathy Hoekstra,


A sweeping measure that would establish government-run universal healthcare in California cleared its first legislative hurdle Wednesday as scores of supporters crammed into the Capitol to advocate for a single-payer system.

The Senate Health Committee approved the measure on a 5–2 vote after a nearly three-hour hearing, but Democrats and Republicans alike signaled unease with the major question still unanswered in the legislation: how the program would be paid for.

The bill, SB 562, would establish a publicly run healthcare plan that would cover everyone living in California, including those without legal immigration status. The proposal would drastically reduce the role of insurance companies: The state would pay for all medical expenses, including inpatient, outpatient, emergency services, dental, vision, mental health and nursing home care.

The measure says the program would be funded by “broad-based revenue,” but does not specify where that money would come from. …

“How can we go forward with this bill without a fiscal analysis, a detailed financing plan?” asked Sen. Janet Nguyen (R-Garden Grove). …

SOURCE: Melanie Mason, Los Angeles Times