YET another needless death — Shoreline Community College professor Troy Wolff, killed last week on his way home from a Sounders game — apparently by a man with unchecked psychosis, and we wonder, yet again, what can be done to patch the corroded public mental-health system.
There is a possible answer this time.
Beginning next week, Washington state begins a vast expansion of Medicaid as part of the rollout of the Affordable Care Act (ACA), aka Obamacare.
The ACA’s creation of health insurance exchanges for individuals and small business has generated more attention, with about 130,000 people expected to quickly enroll.
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Lesser noticed, but even larger in scope, is expansion of Medicaid, the state-federal program providing health care to the poor. The ACA broadens Medicaid eligibility further up the income scale (up to $32,500 for a family of four). For Washington, the expansion is expected to cover 328,000 new people.
Together, they contribute to the greatest seismic shift in health care since the creation of Medicare and Medicaid in 1965. It’s here. Enrollment begins Oct. 1, and coverage kicks in Jan. 1, 2014.
For mental-health care, Medicaid expansion has the potential to be revolutionary. For the first time, destitute childless adults, typically not eligible for Medicaid, will become eligible. Seattle’s Downtown Emergency Services Center alone has 27 staff ready to sign up homeless clients for health-care insurance.
It once took as long as 45 days for the state to check for Medicaid eligibility. Streamlined verification should shrink that to 45 minutes.
Once people are enrolled,five Medicaid-managed care plans in King County must provide full parity between physical-health care and mental- health and chemical-dependency services. No more cap of 12 visits with a behavioral-health care specialist, as was previously the Medicaid rule.
Imagine the savings — for businesses, for the criminal-justice system, for human potential — of true preventive mental-health care.
Medicaid expansion is not a panacea for mental health. The state will maintain a stand-alone system to provide crisis care to the most chronically mentally ill. An expansion of Medicaid may take some pressure off, but this system — particularly in King County — remains beggared by five consecutive years of cuts by the Legislature to funding that pays for many psychiatric hospitalizations.
Medicaid expansion may also strain the capacity of the health-care system. To lure more medical providers to Medicaid, the ACA includes a two-year boost in reimbursement rates. Is that enough, especially in specialties like behavioral-health care? We’ll see.
The biggest challenge for Washington state is to get Medicaid expansion
right, because the 25 states that declined Medicaid expansion will be watching. Republicans in the U.S. House continue a quixotic obsession with denying millions of poor people health insurance.
Washington’s Legislature embraced expansion because, once the ACA became the law of the land, it made fiscal and moral sense. For too long, low-wage work largely shut the door to health care. That ends Oct. 1.
If you think you may be eligible or know someone who might be, go to wahealthplanfinder.org or call toll free 855-WAFINDER.