Members Speak About Medicaid

APA regards the Medicaid crisis as a top priority because that program is the largest source of funds for public mental health services.

Some of our patients with serious and persistent mental illness and other forms of mental illness have already been damaged by the cutbacks. All are vulnerable to future cuts.

The Council on Advocacy and Public Policy is working with trustees and staff to lobby Congress for the immediate provision of additional federal funds to provide short-term relief for state Medicaid programs. We are also working with the National Governors Association to ensure that any congressional restructuring of Medicaid does not adversely affect patients with mental illness.

An APA staff team is developing resource materials, such as fact sheets and sample press releases, to be used by district branches as they confront this crisis and is working collaboratively with other mental health organizations to preserve access to psychotropic medications.

—Jeremy Lazarus, M.D., chair of the APA Council on Advocacy and Public Policy

APA’s advocacy on behalf of Medicaid helps private institutions, such as Sheppard Pratt, provide important acute and long-term care to the public patient. In fact, most care provided by the Sheppard Pratt Health System is funded with public dollars. Medicaid is the principal payer for children and adolescent acute and residential care and for psychosocial rehabilitation services for adults with serious and persistent mental illness. The program funds case management services, which are key to an effective community-based system of care.

—Steven S. Sharfstein, M.D., APA vice president and president and CEO of the Sheppard Pratt Health System

It’s impossible to overestimate the importance of Medicaid in terms of providing services to people with serious and persistent mental illness, who are among the most vulnerable populations we treat.

Medicaid is also threatened in other ways. The Bush Administration announced a plan in January to turn Medicaid into a block grant program. If enacted, persons with mental illness would lose important protections, such as those affecting access to medication, and states would have greater latitude in cutting benefits. Federal officials had already weakened requirements for Medicaid waivers, making it easier for states to cut benefits and people served.

I fully support the contention of Dr. Paul Appelbaum [outgoing APA president] that the entire mental health system, public and private, is being systematically defunded. Cost shifting becomes impossible because there is no sector that can absorb additional costs. If patients lose Medicaid benefits, they likely will exacerbate the already difficult situation in emergency rooms, clinics, and hospitals.

—Selby Jacobs, M.D., a member of the APA Committee on Public Funding of Psychiatric Care, director of the Connecticut Mental Health Center in New Haven, Conn., and a professor of psychiatry at Yale University School of Medicine