States’ Decision on Expanding Medicaid Will Impact Inpatient Psychiatric Care

States that opt not to expand their Medicaid rolls when that option becomes available next year under the Affordable Care Act may be courting disaster, because at the same time the federal government will begin to reduce—ultimately by 50 percent—the Disproportionate Share Hospital (DSH) payments that general hospitals receive for care of the uninsured. So states that do not expand Medicaid rolls to those earning 133 percent of the federal poverty level will continue to bear the burden of care for the uninsured, but with substantially less federal DSH support. And since a great many of those uninsured are psychiatric patients, the funding shortfall is likely to fall heavily on the care of mentally ill individuals.

Joseph Parks, M.D., medical director of the Missouri Department of Mental Health, is raising alarms about this little-discussed provision in the ACA that he believes could dramatically affect state mental health budgets and patient care. Parks contacted Psychiatric News and began raising red flags with colleagues in other states after a study ordered by Missouri Gov. Jay Nixon (D) looked at the pros and cons of Medicaid expansion on four Missouri hospitals. The results of that study, outlined in a Psychiatric News report now on the APA Web site showed that without the Medicaid expansion the state would be left with millions of uninsured patients and significantly less—some $250 million less—in federal DSH support for indigent care.

“States that do not opt into the expansion are really going to be caught in a very tight payment vise as they try to provide care to the uninsured with psychiatric conditions because they are going to be getting little or no compensation from federal agencies," said Joel Miller, senior director of policy and health care reform for the National Association of State Mental Health Program Directors, commenting on the Missouri study.

Read the Psychiatric News article here. 

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