The Problem With Mental Illness and Medicaid

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The Problem With Mental Illness and Medicaid

This article is not meant to diagnose or provide medical advice—that responsibility lies with physicians. The author is not a licensed medical professional.

Carrie Fisher  spent her life trying to lift the stigma on mental illness and addiction, with her death casting a rare light on what is often only whispered about in the corner at family dinners. The late advocate and actress told Vanity Fair in 2009, “If you claim something, you can own it. But if you have it as a shameful secret, you’re fucked.”

Her first stint in rehab came years after she was first diagnosed with bi-polar disorder, after she nearly overdosed. Long-term rehabilitation is often the most effective treatment when it comes to taking control of a mental disorder or addiction, but if you’re not a well off or famous person who can afford private rehabilitation, there are limited options available to you. This is especially true if you receive assistance from Medicaid.

As Republican lawmakers work to repeal the Affordable Care Act (ACA), it begs the question: with mental health care a complex puzzle on its own, how will it stand up to potential Medicaid cuts under a Trump presidency?

Medicaid is a joint federal and state program that provides health coverage for low-income adults, families and children, pregnant women, the elderly and people with disabilities.

More than 72.5 million Americans receive Medicaid, making it the country’s single largest source of health coverage. A coverage provision of the ACA is the expansion of Medicaid eligibility to more qualified adults, making care more accessible to the masses.

The Numbers

Last June, the Substance Abuse and Mental Health Services Administration (SAMHSA) published its directories of mental health treatment facilities and drug and alcohol abuse treatment facilities. These serve as listings of federal, state and local government facilities and private facilities that provide mental health and substance abuse treatment services, respectively.

Of these 23,138 facilities, just about 4,199 offer long-term treatment, according to my research, meaning you live as a resident for an extended period of time (anywhere from 30 days to a few months). Of this group, I found 2,431 that accept Medicaid insurance.

Chances are if you are not swimming in cash, you might have limited options available near home if either you or a loved one requires intensive treatment in order to heal.

Problems with Finding Care

“I travel two and a half hours to the psychiatric facility in Charleston, where I still go for outpatient therapy and outpatient ECT,” said Allison Williford, who has Type I Bipolar Disorder. Williford has been through three hospitalizations, outpatient rehabilitation for alcohol and drug abuse, and has been undergoing electroshock therapy since March 2015.

Though she has private insurance, Williford still runs into issues when it comes to locating a provider. “There are a lot of places in the U.S. that have extremely limited access, or they have doctors who can’t or won’t handle certain cases. I’ve personally experienced it,” she revealed. “I’ve had outpatient psychiatrists who have told me flat out they don’t treat patients with bipolar disorder, or patients who have a history of hospitalization. It can be extremely discouraging, and when you’re already suffering from a mental illness, it just makes you want to give up even more.”

In Orlando, my current city, there are not many inpatient facilities that accept Medicaid. According to my heavy research, two of them are hospitals that only accept patients admitted through the emergency department. As a nurse from Florida Hospital for Behavioral Health told me over the phone, they’re not meant to be long-term solutions. Most patients are gone in a matter of days.

The facility I visited, Aspire Health Partners’ Center for Drug-Free Living, is a rehabilitation and addiction-receiving center that focuses on mental health and substance abuse treatment and provides detoxification and stabilization for adults.

Located in the Parramore District, one of Orlando’s poorest neighborhoods, there was a liquor store just two doors down—a confusing sign for an abuser who might not even be on the road to recovery yet. I parked in a small lot that offered five available spots. There were more cars parked beyond a large chain link fence, which loomed forebodingly as I was buzzed through via an intercom system.

Under HIPAA Law, facilities do not permit outsiders to get past the lobby unless you are with a family member who has been admitted. I stepped into the tiny white lobby and picked an admission packet off a nearby table.

In addition to letting the reader know that they will be provided with medical scrubs to wear during their stay, the packet provided a list of items you’re permitted to bring into your unit. This included five pairs of socks, five pairs of underwear, one pair of pajamas, one pair of shoes and up to $5 in cash (“preferably change”). Other attached documents include an optional Certification of Homelessness.

Individuals that are admitted to the detox facility stay for up to seven days before they are referred to another program to continue their treatment. The problem? There aren’t many local options left after that point.
When I called the National Alliance on Mental Illness’ Orlando chapter, they gave me the same advice they give those who are seeking treatment for either themselves or loved ones and dealing with insurance issues: just start calling. Chances are though, after you’ve called several facilities, that you might need to leave your area in order to seek treatment. If you hadn’t already given up on your search.

“There aren’t many long-term facilities in the U.S. anymore, especially state facilities, as many of them have been shut down in the last 30 years or so,” said Williford. “There’s been a huge lack of funding toward psychiatric care, so beds are incredibly limited.”

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