Traditional Medicaid eligibility varies by state, but is generally limited to low-income children, women, older adults and people with disabilities who receive Supplemental Security Income (SSI).
The Affordable Care Act (ACA) allows states to expand Medicaid eligibility (the process is referred to as "Medicaid Expansion") to uninsured adults and children whose incomes are at or below 138% of the federal poverty level (FPL), including many who live with mental illness. Not every state has opted to expand Medicaid leaving many people living with mental illness without access to affordable health insurance.
Why Are States Requesting Waivers to Expand Medicaid?
The U.S. Department of Health and Human Services (HHS) has the power to approve experimental programs that would benefit low-income people not traditionally covered under Medicaid using the Section 1115 waiver. States that did not choose to expand Medicaid can apply for this waiver to expand coverage.
States involved in the Section 1115 waiver project have taken a unique approach to Medicaid coverage using private health insurance plan options. Some have introduced cost-sharing or co-pay requirements for participants and limited certain types of coverage such as non-emergency medical transportation (NEMT). Additionally, services such as Assertive Community Treatment (ACT), psychiatric rehabilitation and housing supports–which are covered in many existing Medicaid programs–may not be covered.
Where Does NAMI Stand
Expand Medicaid in Every State
NAMI urges that Medicaid be expanded in every state with adequate mental health services and supports included in the plans. Expanding Medicaid doesn't mean that every state has the same quality of care. While the federal government offers incentives to adopt robust plans, not all states take advantage of them. NAMI wants to ensure that every state chooses the best plan for people living with mental illness so that they can get services they need.
States Should Apply for Section 1115 Waivers
If a state has expanded Medicaid we urge them to apply for Section 1115 waivers to have adequate mental health services and supports included in the plans. Measures like cost-sharing agreements have the potential to reduce enrollment and limit access to necessary treatments. While expanded eligibility is wonderful, Medicaid expansion programs must provide people with the coverage necessary to achieve recovery.
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