Let’s Strengthen Medicaid, Not Gut It

Medicaid is a lifeline for millions of Americans with mental health and substance use challenges. Yet, lawmakers are considering drastic cuts to that lifeline, stripping coverage from millions and limiting access to essential care.

Medicaid is the largest payer for substance use disorder treatment and mental health services in the U.S.

Of the 72 million people with Medicaid coverage, an estimated 15 million are adults with mental illness, according to KFF. Among that population, the most common co-occurring chronic condition is substance use disorder, with 1 in 4 Medicaid enrollees diagnosed with mental illness also having a diagnosed substance use disorder.

If funding is slashed, the consequences will be devastating.

What’s being proposed?

By making massive cuts to Medicaid, the federal government would effectively force states to make a choice — spend more of their own money to fund Medicaid, restrict the number of people covered or provide fewer benefits. Lawmakers are considering changes that would:

• Give states flexibility to impose premiums on beneficiaries.
• Create work requirements and lifetime caps on Medicaid coverage.
• Force states to cut the number of enrollees or reduce benefits.
• Reduce payments to doctors and providers, leading to fewer services.

“These proposals don’t directly alter eligibility for Medicaid or the benefits provided, but the ultimate effect would be fewer people with health coverage,” Larry Levitt , executive vice president for health policy at KFF , told CNN. “When you erect barriers to people enrolling in Medicaid, like premiums or documenting work status, you end up rationing coverage by complexity and ability to pay.”

But what would cuts look like in terms of patient care? In the most general terms, people would likely see more barriers to access, and the cuts would be catastrophic for those who rely on Medicaid for mental health and substance use treatment and care.

“Patients with chronic conditions or ongoing mental health needs may stop coming to their appointments. Prescriptions may go unfilled as patients cannot afford the out-of-pocket cost, making it difficult for providers to manage patients’ conditions. Patients may only go to the doctor after a medical problem has become so severe that they are left with no choice, making treatment more challenging,” Megan Cole Brahim, codirector of the?Medicaid Policy Lab?at Boston University School of Public Health told BU Today.

Gutting Medicaid is the wrong move

Cuts also would be catastrophic for all community-based health providers. Brahim said providers would see uncompensated care costs rise and total patient revenue decline, which could result in the reduction of staff and services.

Few programs have helped support the organizations that provide mental health and substance use care as much as Medicaid. Every National Council for Mental Wellbeing member relies on the program.

So much great work has been done to eliminate barriers to care and support those with mental health and substance use challenges. It’s important to ensure that people have access to comprehensive, integrated care as early as possible and that care isn’t interrupted.

Failing to provide access would be a recipe for disaster. Making drastic changes to mental health programs could put people in jeopardy, cause their conditions to worsen and require more costly care down the line. In addition:

• Emergency rooms could become the de facto primary care provider for people in crisis.
• Fewer people would be able to afford medication.
• An increase in overdose deaths is likely, just as deaths are beginning to decline.

While specific details on budget reconciliation legislation have yet to be announced, reforms to Medicaid and other entitlement programs will likely make up a significant portion of proposed spending cuts. We expect to see specific legislative proposals soon, and we need to continue our outreach. Please take two minutes to use our advocacy platform and send a letter to your elected officials.

You can also call your member of Congress. Use this template call script if you need suggestions. Feel free to make it your own! You can find your officials’ contact information here — just type in your name and address.

Your voice matters! Let your elected officials know that Medicaid remains one of the most important federal health care programs available. More than three-fourths of adults (77%) hold a favorable view of Medicaid, and 46% say not enough is spent on Medicaid.

Now is the time to strengthen Medicaid, not gut it. Contact Congress today and urge lawmakers to preserve Medicaid and protect access to mental health and substance use treatment and care.