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Presentation to the Oversight Committee on TennCare
State of Tennessee

Monday, April 25, 2005

Katrina Gay, Chief of Field Operations
NAMI, the National Alliance for the Mentally Ill

Thank you, Representative Bowers, for inviting NAMI to present to the Committee. I am here today representing the National Alliance for the Mentally Ill. I am a proud Tennessee resident, having lived in Hendersonville with my family for the past 13 years, and I commute to the national organization's office periodically for my work. One initiative on which I engage is The Campaign for the Mind of America which launched here in Tennessee in early March with the release of a report outlining solutions to the current fiscal crisis we face with respect to TennCare and proposed cuts. The Campaign is currently active in 13 states across the country; therefore, I am afforded a perspective on other states' Medicaid and policy efforts that affect people with mental illness.

I am speaking as well for Sita Diehl, NAMI Tennessee's Executive Director, who asked me to extend her apologies for not presenting herself. She is today in East Tennessee speaking in two communities offering NAMI support and education, speaking to your constituents

As a Tennessean, when I first engaged in citizen advocacy efforts ten years ago, my son with mental illness was eleven years old and very ill. I learned quickly the necessity of a strong system of care in our then newly-formed TennCare program for people like him. I knew that some day, he might very well depend on this system for his care and for his life. I knew that I had to engage then so that if he required the benefits of TennCare, if it was as it is today the only real option for services and treatments others like him need, that services would be there and would be responsive to save him from the horrors of his illness.

I am sad to say that as my son turns 21 this year, I see, and I have to report that the country sees, the impending erosions of care in TennCare as a very potentially significant step backwards for Tennessee's most vulnerable citizens. It is as if ten years of progress is about to be swept away. We know so much about mental illness, and I know the Committee understands the necessity of treatment and the possibilities of recovery. We owe it to our citizens, to families like mine and to people like my son to ensure that people with mental illness have the opportunity for life and not the tragedy these illnesses so often claim.

Today, I have been asked to address three issues relative to our current TennCare crisis and offer insight into other states responses to similar circumstances: (1) The current environment of Medicaid programs in states across the country (2) The necessity of ensuring Medicaid coverage for people living with mental illness and how other states respond, and (3) The necessity and practices of ensuring protections to services and treatment, including essential medications, for people with serious mental illness in Medicaid.

In recent years, many other states have been expanding their Medicaid programs to include eligibility to optional populations. They have done so in many cases to capitalize on the federal match that the Medicaid program affords to their healthcare budgets, to enhance their state's economies, and to address the increasing burden of the growing population of the uninsured. As state budgets have been in crisis recently, however, they have begun to slash many of the service that these beneficiaries receive.

As certain states take this action, they WISELY look to particular populations in their programs and examine benefits options. Among those priority populations are people with mental illness who are recognized as a protected class requiring open access to services, medications, and treatments that are not "usual" to other illnesses and disease groups.

I site three examples of recent action in this area:

  • Recently, in Oregon, leadership acted to protect the benefit services for mental illness in their program while taking action to reduce certain services to the overall Medicaid recipient.
  • In Missouri over the past few weeks, Governor Blunt indicated that he is working with his Medicaid division to take steps to exempt mental health from being included in benefits restrictions being considered. It is understood that he recognizes that cutting people with serious mental illness from the Medicaid rolls will have serious adverse consequences to other systems in the state including negative cost implications.
  • And just last week, New York reinstated proposed cuts to their Medicaid program that would have devastated many people living with mental illness.

These states and others like them recognize that people with mental illness in their Medicaid program must be protected, must be provided treatments and services that are unique to ensuring health and recovery. They do this because they understand that the consequences of NOT doing so are disastrous to other aspects of the state budget, disastrous to county and city budgets, disastrous to other community services such as law enforcement and community hospitals, and disastrous for the individuals and their families living with mental illness.

NAMI recognizes that TennCare and other state Medicaid programs are administered through Governors' administrations. However, in statehouses across the country, legislatures are taking steps to provide guidance and assurances for people with mental illness in various ways.

In fact, recognizing the economic and human benefits of doing so, certain state legislatures have established wholesale protections for people living with mental illness.

One of the most widely exercised provisions in legislatures includes protection of access to critical mental health medications. Through specific legislation, through amendments to state budget bills, and through other actions, state legislatures are doing due diligence to protect access to the critical array of necessary medications for people with mental illness. My testimony includes an attachment of the various strategies currently employed by legislatures across the country. I acknowledge the fine work of the National Mental Health Association in the preparation of this document. Certain examples of strategies enacted by state legislatures include:

  • Florida -- where a law was passed in 2000 that ensures protection to access for mental health medications.
  • South Carolina -- where language in their budget bill for the past two years has ensured that people in Medicaid are ensured the medications they need to treat mental illness.
  • Kansas -- where language in their budget bill was inserted last year to provide assurance to this population.
  • Pennsylvania -- who as we speak are exploring options for protective language in their budget bill to secure access for this illness.

States across the country protect access to medications because they understand the necessity of doing so. Consider that this three-pound organ that we call the brain is the most complex structure ever investigated by science. It contains around 100 billion nerve cells, or neurons. Neurons communicate with each other by electrical signals that travel across synapses to other neurons. In total, there may be between 100 trillion and quadrillion synapses in the brain. I don't even know how may zeroes there are in a quadrillion. Can we even imagine it?

Most of us in this room take it for granted that we can think and process information to get through our day, to complete our responsibilities to our families and our jobs, to maintain our wellness. We take it for granted that we could maneuver community safety nets if we had to in order to get medical care. Without unrestricted access to medications men, women and children with preexisting vulnerabilities to brain disorders like schizophrenia and bipolar disorder can and will descend into the hell of depression, of mania, and of psychosis. The person who comes back from that hell is not the same person who descended. That person will often never be the same. That person has suffered brain trauma and every successive episode will presage the next, and the next and the next. Access to the best medications keeps the men, women and children with serious mental illness in Tennessee healthy, in their jobs, in their classrooms, in their communities. They are not in jail, in our emergency rooms, on the streets.

Let's set aside the cost in human tragedy for a moment. The mantra throughout our state is that the TennCare budget is a runaway budget.

Will you save money in TennCare if you have preferred drug lists, limit the number of medications available, restrict access? -- you bet you will. Will you save money if you restrict doctor visits for people living with mental illness? At first glance, on paper, sure.

HOWEVER please ask yourself, are we really saving the taxpayers' money by not allowing care and treatment for people with mental illness? Certain states and community leaders have learned that this is NOT the case. Let's learn from them.

  • A study from New Hampshire -- for every dollar saved on medication for schizophrenic patients, $17 dollars were spent on emergency service to those patients.
  • California -- Forcing people with mental illnesses to switch to cheaper medications cost the state $6,000 to $8,000 per patient due to increased hospitalizations.
  • Emergency Departments report that overcrowding is the largest crisis they face in states when access to services in Medicaid for people with mental illness is restricted. Wait times and capacities to meet the community's needs for emergency care are recognized as very real consequences that impact all our communities, and negative fiscal consequences to the local economy are also realized.
  • And I urge you to ask our Sheriffs, our judges, the county jail personnel, our police officers, those whose duty it is to keep our communities safe. Ask them what the consequences will be and the impact it will have on all of us.

Cutting vital services to people with mental illness is not a solution to our state's fiscal crisis. Other states know this, we know this. We must do the right thing and insist that people with mental illness remain protected from disenrollment and have the critical medications and services they need. I urge the committee to follow the lead of your colleagues in statehouses across the country and recommend protective action.

On behalf of the one in five families in Tennessee living with mental illness and the NAMI grassroots leaders in over 38 communities across the state, I thank you for your time and the opportunity to address the committee. I acknowledge the committee's understanding of the need to listen to the citizens of Tennessee, to the families and consumers who are affected by decisions that are made in our state process, and to the commitment of the National Alliance for the Mentally Ill and their work in supporting our grassroots leaders and the coalition of mental health advocates in Tennessee.

I'd be happy to answer any questions you may have.

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