As Ohio policymakers and mental health agencies prepare for a new budget cycle in coming months, they will do well to look closely at a new report analyzing spending statewide on mental health services that are not covered by Medicaid. “By the Numbers 2,” the report released last week by the Mental Health Advocacy Coalition and the Center for Community Solutions, offers an invaluable reality check. It examines the variety of services necessary for mentally ill residents to remain functioning members of their communities. The analysis reveals a disturbing unevenness around Ohio in the resources available to meet the rising needs in mental health care.
By the nature of the illnesses, mentally ill individuals are best served when treatment and support services are continuous and seamless. As the report reminds, the quality and continuity of care are of such priority that the Substance Abuse and Mental Health Services Administration has defined a continuum that represents a “good” and “modern” system of care. That good and modern continuum covers the spectrum from screening, prevention and treatment services to housing, employment assistance, transportation, respite care and recreation services.
Unfortunately, the study found that Ohio offers just part of the continuum. Further, more often than not, availability is a matter of where a client lives. Ohio Medicaid covers a limited range of treatment services, including psychotropic drugs, crisis intervention and individual and group case management. The federal and state-funded program does not pay for a slew of services that are equally essential to the recovery and social functioning of people with mental illnesses.
As it is, the responsibility falls on local agencies and communities to finance as best they can the diverse physical, social and emotional needs of people with mental illnesses. The support services that Medicaid does not reimburse include housing, protective services, employment assistance, transportation, suicide prevention hotlines, crisis stabilization, court services and training in crisis intervention for law enforcement officers.
The report found that in 2011, the 46 county mental health boards for which it had data together spent about $138 million on services that Medicaid does not reimburse, nearly half of the amount on housing services. Especially troubling, the care continuum in smaller counties without dedicated local levies is very limited.
It is heartening that boards across the state recognize the importance of these services and are struggling to provide them. Which makes the report’s recommendation the more urgent to include in Ohio Medicaid more support services that can draw federal funding.