Monday 17 January 2011

Arizona budget: Mentally ill may lose health benefits


Gov. Jan Brewer's plan to roll back state Medicaid coverage would leave thousands of Arizona's most mentally fragile without health care.
An estimated 5,200 people diagnosed with a serious mental illness and thousands more who qualify for other behavioral-health services would be among 280,000 childless adults losing health-care coverage under the governor's plan.
To mitigate the hit on the seriously mentally ill, Brewer wants to spend $10.3 million to prevent gaps in their psychiatric medication. They would lose coverage for all other medical care, including prescription drugs for physical ailments, as well as case management, transportation and housing they receive through the state's behavioral-health-care program.
Mental-health advocates say losing case management and other connections to the community, along with their general health-care coverage, would be a devastating blow to an already vulnerable population. And it will put a greater burden on hospitals and the criminal-justice system.


"The reality is cutting services does not cut demand," said Ted Williams, CEO of the Arizona Foundation for Behavioral Health and a former state health director. "Individuals who can no longer get services through the state will wind up getting services through emergency departments . . . or they'll get those services through the Maricopa County jail."


Under Brewer's budget, which she released Friday, the newly uninsured seriously mentally ill would join about 14,000 other adults with the same diagnosis who lost services last year. Those people earned too much to qualify for the Arizona Health Care Cost Containment System, but their diagnosis had given them access to a range of community services, including housing and medication, under a 30-year-old class-action lawsuit.


The lawsuit was put on hold last year. Brewer and lawmakers cut most services for those ineligible for Medicaid, effective July 1, but provided $60 million for medication and treatment in the crisis system.


Legislators will use the governor's proposal as a framework as they begin work on the state budget next week.


The state's health director said he believes some of those who would lose AHCCCS coverage under Brewer's plan could qualify for care under another section of federal law that covers disabled adults.


"We think that we can reclassify many of those folks as disabled," said Will Humble, director of the state Department of Health Services. "They are the most vulnerable population we serve. And it will make a huge difference in their lives and the lives of their families."


Thousands more now covered under AHCCCS, however, would not qualify for any federal or state assistance. They include people struggling with depression, bipolar disorder, drug and alcohol abuse, and other behavioral-health problems.


They have not yet been deemed seriously mentally ill, but many of them are on the brink, said Emily Jenkins, CEO of the Arizona Council of Human Service Providers.
"They haven't moved into the SMI population," Jenkins said. "But that doesn't mean that they don't need ongoing medication and treatment in order to manage their illness."

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