Indiana Medicaid Changes

I have lived in Indiana all of my life and unlike many of my friends have never felt an overwhelming desire to leave.  There are many reasons to be angry about the way things go in Indiana, most of our gov’t officials as one example.  But this new change is probably the what has made me the most disgusted about living in Indiana.

Indiana has finally, in accordance with a bill passed in 2006 that allowed states to make changes to medicaid to make it more cost effective, made the changes that they felt necessary to save them some money.

Some of the changes are good.  Most aren’t and many will have side effects that will do the exact opposite of saving money and instead funnel the costs to someplace else.

A good summary of the changes and drawbacks is here

The thing about these changes that piss me off the most is that many of their “cost-saving” ideas aim at taking services away from the chronically mentally ill.  These are the people who are most need of services that are consistent, broad and supportive.    Many programs that had previously been billable that would allow stability and hope into peoples lives are not being cut.  Community Mental Health Centers were designed as a way to stop the massive hospitalizations of those dealing with a chronic mental illness.  They were also a way to combine many types of care. A place where an individual can go to one place to have a Dr for medication,  Daily therapy, vocational help and yes a social and supportive outlet where they felt a connection and that they were being understood.  These medicaid changes work to destroy that balance.

For example: It is an unfortunate fact that those in the population dealing with chronic mental illnesses have higher rates of illness and die earlier than those that are fortunate enough to not have these illnesses.  A community mental health center can provide nurses and physicians as well as nutrition training and other skills to help mitigate that.  Thus ensuring that instead of having to attempt to find or drive all over town, many services are provided in one stop.  The same goes with training on daily tasks and having a social support group.  Most communities don’t have strong public transportation and so finding and managing rides can be difficult and sometimes impossible for those that need them most.  In many of these mental health centers a client can schedule an appointment with their dr/nurse/psychiatrist and then just walk down the hall to join in with a day treatment program, or go work in a “clubhouse” or other activity that promotes independence and skills.  However, under these new medicaid changes, certain types of activities cannot be billed in the same day.  Which means two trips which means it’s twice as hard to manage.  Also,  it is not uncommon for mental health centers to allow clients to arrive late for therapy or leave early to make appointments that are within the center, or even outside of it as they understand t’s easier to arrange rides for one day then rides for two-three seperate days.  Under these new changes a client cannot arrive even 15 minutes late for a service otherwise it will not be billable and/or they will have to be turned away.  Now clients are going to b forced to choose between drs appointments and therapy or filling prescriptions that they need.  These rules would not be an issues for someone who has a car, plenty of time, or the resources to balance things out.  However, for someone who relies on the kindness of family, friends, or minor public transportation, that often times runs at inconvenient or shot times, that time of balance is hard if not impossible to find.

Another issue:  The medicaid changes are identified to focus on a “recovery-based” model.  That sounds all well and good but this is not a cold, or even something like anxiety related to specific stressor that can be dealt with and moved on from.  These are illness that DO NOT GO AWAY.  there is not “recovery” there is learning to manage and maintain.  Instead these new changes require that after a certain amount of time in therapy has been reached a client must be discharged and cannot be entered back into services unless there is a new “crisis”.  These means that someone would have to be hospitalized for suicidal thoughts or have issues with delusions or hallucinations to the point where a professional views them as a danger to themselves and others before they are allowed back in treatment.  So they are eliminating many support groups for those that need them and then making them be kicked out of therapy which is probably their biggest support system left until their illness gets to a point where they are going through emotional hell.

Finally,  many mental health centers are looking at a loss in millions of dollars in revenue.  These are non-profit organizations which put much of their moneies back into services for the community.  It allows them to offer many different group and programs that may be a loss financially but are off set by income from medicaid and other treatments.  As centers start losing money they may have to cut back on staff which means less people to provide quality care, close down beneficial programs as an attempt to save money or do other cost saving methods that do not benefit the community or the clients.  They new strict billing rules for medicaid also make it hard for community mental health centers to employ anyone other than those with certain licenses and qualification.  However, many people with those qualifications can find better hours, better pay and more freedom working at independent agencies who won’t even take medicaid due to these new restrictions.  At times prior mental health centers were a great place for individuals to work fresh out of school to gain experience and learn about helping and giving back to the community.  Many of those people will now be unemployable as they will not be able to provide services.

So tell me again how these changes are supposed to save money?