National Alliance on Mental Illness
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October 26, 2005
Senate Committee Completes Action on Medicaid Legislation; House Committee Action Set for October 27; Proposals to Curb Targeted Case Management Rejected
On October 25, the Senate Finance Committee formally reported important legislation making changes to the Medicaid program in order to achieve a net $10 billion in reductions over the next five years. The legislation, known as “budget reconciliation” is expected to reach the full Senate as early as next week. The House Energy & Commerce Committee will take up its version of the Medicaid “reconciliation” bill on October 27.
Targeted Case Management and Rehabilitation Services Proposals Rejected
Of enormous concern to NAMI as part of this Medicaid legislation are proposals that would have significantly curbed the ability of states to integrate evidence-based programs such as assertive community treatment (ACT) into their Medicaid programs through the existing options of Targeted Case Management (TCM) and Rehabilitation. Earlier this year the Bush Administration proposed changes to the definitions of both TCM and Rehabilitation under Medicaid, changes that would make it difficult for states to qualify intensive case management and ACT programs managed by public mental health agencies and CMHCs for Medicaid funding.
Both the Senate Finance Committee bill and a preliminary draft of the House Energy & Commerce bill exclude the Bush Administration’s recommendations for redefining TCM and the Rehabilitation option. The apparent rejection of this proposal is a major victory for Medicaid recipients with mental illness. NAMI is extremely grateful to Finance Committee member Senator Gordon Smith (R-OR) and others for their leadership in pushing to ensure that these proposals were rejected.
New Waiver Proposal to Examine Access to Acute Care and the IMD Exclusion Approved
In its deliberations, the Senate Finance Committee endorsed a proposal from Senator Olympia Snowe (R-ME) to create a new demonstration program allowing states greater flexibility to avoid current restrictions on Medicaid funding for acute inpatient psychiatric care. This amendment would allow for waiver of the so-called Institutions for Mental Disease (IMD) exclusion for acute psychiatric care. NAMI supports the Snowe Amendment. This important waiver program would allow states the ability to waive the restrictions of IMD and invest Medicaid funds in acute inpatient care. The demonstration will measure the efficacy of acute inpatient care in improving outcomes and reducing reliance on other high cost services such as emergency room care.
House Legislation Likely to Include Higher Co-Payments for Certain Medicaid Beneficiaries
The House Energy & Commerce Committee proposal is expected to include a controversial proposal developed by the National Governors Association (NGA) to allow states the ability to require most Medicaid recipients to pay higher co-payments for health care services including doctors visits and prescriptions. This would be a state option and would include certain required exemptions for beneficiaries below 100% of the federal poverty level.
Other proposals under active consideration include:
NAMI will be providing additional details as progress on the Medicaid budget reconciliation measure moves forward.