Most of Sonoma County psychiatric patients sent out of county for hospital care
It's a rule as old as the landmark 1965 program establishing Medicaid -- the government-provided medical insurance for the poor and disabled -- and it bars federal dollars from being used for adult patients treated at certain kinds of psychiatric facilities.
Known as the IMD Exclusion, the rule was drafted at a time when mental health professionals, advocates for patients and some federal lawmakers were trying to end the notorious era of psychiatric asylums.
That era is over, but the rule still exists. And in
Mental health patients under the county's care are often sent to psychiatric hospitals in other counties because the county would have to pay the full cost of care at Aurora with no federal financial match.
"We don't want to change the IMD exclusion. We don't want warehouses anymore," said
The
It would also have allowed states to more easily waive Obamacare's 10 essential benefits, which include mental health coverage. But the fact that it addressed the IMD exclusion is a hopeful sign for those who have been struggling to get lawmakers to take note of the outdated rule.
"Leaving aside the other issues in the bill, this is a really important aspect for the mentally ill and should be pursued in order to allow for effective care," said
The
The federal funding exclusion did not apply to psychiatric units tied to acute general hospitals. Before it became Aurora in 2013, that facility was operated by
Ever since the closure of the two local psychiatric hospitals, the funding exclusion has been a thorny issue for Kennedy, who says it forces him to send patients to other counties for treatment in psychiatric hospitals that accept
Last year, the county mental health department referred about 1,000 individuals to psychiatric hospitals, with about 71 percent covered by
The county spent more than
Kennedy says the rule does not take into account how the landscape of psychiatric hospitals has changed.
During the 1980s, general acute care hospitals began shutting down their psychiatric units for financial reasons. What popped up in their place were short-term freestanding psychiatric hospitals like Aurora.
The federal exclusion has been amended to make exceptions for youths under 21 and adults 65 and older. And in recent years, some exceptions have been granted to states with managed care mental health programs.
In 2016, the county
The rest, 71 percent, were covered by
The county mental health department could try to refer all of its
Making an exception for short-term freestanding hospitals would allow the county to draw down more
"When somebody's really in bad shape psychiatrically, and psychotic, they need a hospital for a few days," Kennedy said. "We have to have that. ... A lot of times they wind up in the ERs or law enforcement is picking them up."
Another possible way around the IMD exclusion is establishing a 16-bed psychiatric health facility or PHF, which in terms of care is equivalent to a psychiatric hospital. But because it has fewer than 17 beds, the cost of care provided there for adults can be billed through the
But an end to the outdated IMD exclusion is long overdue, said Snook of the Treatment Advocacy Center. And if the failed
This report was produced as a project for the California Health Journalism Fellowship, a program of the
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