This article first appeared in the St. Louis Beacon, March 5, 2013 - When Gov. Jay Nixon decided to visit the Metropolitan St. Louis Psychiatric Center to make a case for expanding Medicaid, few people in the audience were more pleased than Dr. Roy Wilson, the center’s medical director. He says the visit helped to shed more light on the fact that facilities like his often lack the money for services to head off the adverse consequences of being mentally ill and uninsured.
“I think (Nixon) has called attention to a very important problem, and it’s a great opportunity for Missouri. Without Medicaid, we often have people who don’t get services, end up homeless, in emergency rooms, in jails and prisons because the don’t get the care that they need and that we know how to give.”
Wilson was among several health and law-enforcement officials who joined Nixon at the center to talk about the value of expanding Medicaid for mental health reasons. Mayor Francis Slay and St. Louis Police Chief Sam Dotson were among the St. Louis officials at the event.
In spite of the enthusiastic response to the governor’s pitch, he has yet to convince the GOP-dominated Missouri legislature to support expansion. Many GOP legislators say the state can’t afford the cost. But the governor noted that Missouri would pay nothing during the first three years of an expanded program, which would cover 300,000 residents, including 50,000 with mental health problems.
Missouri would eventually have to cover a maximum of 10 percent of the cost of expanding the program, but Nixon added that even that amount was a good deal for Missouri because much of the state’s funding for mental health comes from general revenue.
“Law enforcement, professional and psychiatric medical professionals see tragic and dangerous consequences of mental illness first-hand each and every day,” Nixon said. “Right now many people with mental illness don’t have health insurance, and they go years without treatment. For their families it’s a tragic and vicious cycle, sapping them financially, exhausting them emotionally.”
Nixon also released a new Department of Mental Health studyon the impact of strengthening Missouri’s mental health system. It said Missouri hospitals will lose money even if the state doesn’t expand Medicaid because the Affordable Care Act will reduce federal funds to assist hospitals in caring for the needy. The assumption, the report notes, is that these patients will be served by an expanded Medicaid program. By failing to expand its program, the report said Missouri would not be able to “improve its community outpatient services and runs the risk of severely damaging its psychiatric inpatient services.”
Dotson was more blunt: “Our community should not live in fear that these people are not going to be identified and receive the proper treatment. Some issues need to be dealt with before they threaten the public safety. Mental illness is one of those issues. Every day our officers encounter people with severe mental illnesses, posing threats to themselves and to the public. There needs to be intervention before these people reach the crisis point."
Expanding on the local discussion was Herb B. Kuhn, president and CEO of the Missouri Hospital Association in Jefferson City. He noted that a big portion of the state’s behavioral health resources are situated in hospital.
“These assets are strained because a large percentage of mental health patients are uninsured and unable to pay for their care,” he said, adding that this is one reason hospitals provided a record $1.1 billion in uncompensated care in 2011.
He said the loss of disproportionate share payments to hospitals for treating the needy, along with other federal cuts to hospitals under the Affordable Care Act, meant Medicaid reform was essential in Missouri. Otherwise, he said, “This could result in fewer behavioral health resources in community hospitals throughout the state.”
