Health Care

Report: Medicaid expansion could boost access to treatment for mental illness, substance abuse

Nurses, civic activists had a march and rally to commemorate the 50th anniversary of Medicare and Medicaid, the public health insurance programs for elderly and low-income people, July 30, 2015.
Nurses, civic activists had a march and rally to commemorate the 50th anniversary of Medicare and Medicaid, the public health insurance programs for elderly and low-income people, July 30, 2015. pbosch@miamiherald.com

Expanding Medicaid could allow more than 300,000 Floridians to gain access to treatment for mental illness and substance abuse, according to a new federal government report.

Some 726,000 people living in Florida have a mental illness or substance abuse disorder but don’t have health insurance, according to the report, released Monday by the U.S. Department of Health and Human Services.

States are allowed to expand Medicaid health coverage to households that earn 138 percent of the federal poverty level — $16,284 for an individual or $33,534 for a family of four.

“If states are serious about addressing mental illness, opioids and other substance abuse disorders, expanding Medicaid will provide them a unique opportunity,” said Richard Frank, assistant health and human services secretary for planning and evaluation.

Florida is one of 29 states that have not opted in to Medicaid expansion.

The Florida House and Gov. Rick Scott fought hard last year against an expansion proposal and the governor shows no sign of changing his position.

Asked if Scott would consider Medicaid expansion as a way to address mental illness, Scott’s office pointed instead to existing state programs.

“The Florida First Budget the governor signed this month provides mental health services to thousands of additional Floridians,” spokeswoman Jeri Bustamante said in a written statement.

The state budget includes $1.1 billion for mental health and substance abuse services, including five additional mobile teams to provide services to mentally ill children and their families, including in Pasco and Palm Beach counties. And lawmakers this year passed sweeping changes to the state’s mental health and substance abuse treatment system.

Federal officials argue that expanding Medicaid would save the state money in other parts of the budget.

For example, Florida prisons chief Julie Jones estimated last year that 40 percent of the state’s inmates have some sort of mental illness. And much of the money in Florida’s mental health budget is spent on the state’s mental hospitals, some of the most expensive patients.

“Yes, there are budgetary impacts in long run,” Frank said. “But there are huge human gains, huge economic gains as a result of expanding.”

Opponents of Medicaid expansion argue that the state would be on the hook to pay for health coverage far down the road when federal money to subsidize the program might not be a guarantee.

The federal government would cover the full cost of expansion through this year and gradually decrease its support to 90 percent in 2020. President Barack Obama has proposed covering the total cost for the first three years in any state that expands Medicaid.

Contact Michael Auslen at mauslen@tampabay.com. Follow @MichaelAuslen.

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