Providers say repeal could impact mental-health services

March 11--As Congress debates the future of the nation's health care system, Montanans are left wondering what changes could mean for the state's Medicaid program and the people relying on it to tap into mental health services.

"It is a scary time with the idea of the Affordable Care Act going away and not knowing what that could look like," said Diane Conti with the Western Montana Mental Health Center. "Whatever is decided, it's going to impact so many facets of health, especially mental health."

Montana's Medicaid expansion brought coverage within reach for adults with incomes up to 138 percent of the federal poverty line.

So far, 71,000 Montanans have gained health covered through the expansion. More than 7,000 of those enrollees are Flathead County residents.

Current legislation that would unravel the Affordable Care Act, also known as "Obamacare," would cut off federal funding for new expansion enrollees in 2020. It would also set limits on how much each state receives for its Medicaid program.

Throughout the 2016 national elections, Republicans promised to repeal or replace the Affordable Care Act. The law covers nearly 20 million Americans, but opponents have pointed to large health insurance rate increases two years in a row.

"We all know the Affordable Care Act is not perfect," Conti said. "But to be able to increase people's ability to seek help is important."

A report released by Harvard Medical School last month stated that 17,598 Montanans with a mental illness or substance use disorder gained health coverage through the Affordable Care Act marketplaces. Another 10,880 gained coverage through the state's expansion.

Conti said the mental health center in Kalispell provides care to roughly 600 people. She said 75 percent of those clients rely on Medicaid. Of those people, 91 gained coverage through the expansion.

"When our folks are able to get access to care because they have coverage, that means they aren't in emergency rooms, they aren't going to the state hospital as high-utilizers ... it's had a huge impact in them being able to afford their medications," she said.

IN A RECENT interview, Sheila Hogan, director of the state Department of Public Health and Human Services, said she's "excited about the medication expansion efforts" and what it's meant for mental health services.

"There are 71,000 people enrolled in the expansion," she said. "So now people who are chemically-dependant, we can actually provide that paid treatment for them."

Jon Ebelt, a spokesman for the health department, said under the Medicaid expansion, more Montanans are receiving comprehensive coverage. He said the expansion included coverage for chemical dependency, behavioral health treatment, screening and diagnosis.

"Before ... mentally ill adults had to qualify for a waiver, be pregnant or parenting or be disabled to get access to Medicaid mental health services," Ebelt wrote in an email.

Prior to expansion, limited state dollars were used to provide mental health services through the state's Mental Health Services Plan. The plan extended to Montanans with a serious and disabling mental illness who couldn't afford insurance and fell short of qualifying for Medicaid.

The Medicaid expansion largely replaced that plan, Ebelt said.

In fiscal year 2015, prior to expansion, the state spent more than $1.6 million to serve 2,119 Montanans in the plan. As many of the plan's users signed up for the expansion the following year, the state's cost for the program dropped to $306,899.

Medicaid covers mental health services from outpatient therapy to acute hospital care for mental health emergencies, such as suicidality. Adults with a severe illness such as schizophrenia can couple substance abuse treatment with physical care.

"Medicaid allows adults to receive mental health services before their condition becomes acute and requires an emergency room visit," Ebelt said.

Hogan said the department is having "a lot of discussions" on what shape health reform may take. But for now, she said it's too early to know what might happen.

"We're looking at everything," she said.

CONTI said before the expansion, many of her clients relied on the state's Mental Health Services Plan. But she said when the plan's funding dried up toward the end of each year, the center often absorbed the cost of treatment for patients who couldn't afford to pay.

She said if Congress reforms the nation's health care system, she'll be watching for what comes next for Medicaid and Montana's expansion.

"Without that, it obviously makes it hard for us to provide services," she said. "If that funding is reduced or gone, we'd have to look for another plan -- but we're a business too. As much as what we do is good work, we still have to be able to keep the doors open."

Reporter Katheryn Houghton may be reached at 758-4436 or by email at [email protected].

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