The linked crises of drug addiction and homelessness have Washington on the verge of embracing a health care provider it once repudiated: the mental hospital.
Nearly 60 years after Congress barred Medicaid from treating people in what were then derided as insane asylums, lawmakers are on the verge of reversing course.
The reasons: Community-based care championed since the 1960s hasn’t stopped record overdoses — and constituents have had it with the brazen drug use and tent encampments in their cities. Some public health advocates agree that times have changed and the magnitude of the crises justifies lifting the rule.
“It is no longer the 1960s, and there is no longer the same stigma against the treatment of mental health,” said GOP Rep. Michael Burgess, a doctor representing Dallas’ affluent northern suburbs who sponsored a House bill to change the rule.
The House passed it Dec. 12. It would give states the option to treat Medicaid patients suffering from addiction for up to a month in a mental hospital on the government’s dime. The Senate Finance Committee approved a similar provision in November, so its prospects of enactment are good.
Burgess’ co-sponsor was Ritchie Torres, a Democrat from New York City’s poorest section, the South Bronx, who has spent time in the hospital for his own mental health struggles.
Public health groups including the Treatment Advocacy Center and the National Alliance on Mental Illness, as well as state Medicaid directors, support the change.
They say the 1965 rule barring Medicaid, the federal-state health care program for the poor and lower-middle income, from funding hospital treatment has had unintended consequences: a lack of psychiatric beds for people who need them. Instead, they said, many vulnerable people end up on the streets, in emergency rooms, in jails or dead.
They say the policy also perpetuates discrimination against people who suffer from drug addiction and mental illness compared to those with physical conditions, for which there’s no such exclusion.
Republicans in Congress agree. Democrats are divided.
New Jersey Rep. Frank Pallone, the top Democrat on the Energy and Commerce Committee that shepherded the bill, resisted the change, wary of a return to institutionalizing people with mental illness instead of caring for them in their homes, ideally, with a team of specialized health and social workers.
“We know that one of the best ways to help people in recovery is to ensure they have access to care in their communities,” he said.
Pallone ultimately relented because Republicans agreed to improve Medicaid coverage for some incarcerated people with substance use disorder.
But fears of reinstitutionalization have also animated civil rights advocates who support the restriction on Medicaid funds. They fear........