December 2006, Vol. XXIII, No. 14
Upcoming recommendations from a bipartisan presidential commission on possible long-term changes in the Medicaid program have mental health advocates sitting on the edge of their seats. The first draft of the recommendations was scheduled to be released on November 8, according to the Medicaid Commission's executive director, Stacie Maass. A 2005 congressional law requires the commission to submit final recommendations intended to help ensure the long-term sustainability of Medicaid to the Secretary of Health and Human Services (HHS), Michael O. Leavitt, by December 31, 2006. Leavitt is expected to translate those recommendations into a legislative proposal and to submit it to the new Congress in early 2007.
Leavitt's Medicaid reform proposal is expected to have a tremendous impact on mental health care, since Medicaid is the biggest payer for psychiatric services in the United States. Mary Giliberti, JD, director, public policy and advocacy, National Alliance on Mental Illness (NAMI), was contacted before the release of the November 8 draft recommendations. "We have general concerns about what will be in the report," she said.
NAMI representatives made a number of appearances before the commission as it held public hearings throughout 2006. Steven Buck, who was director of state policy for NAMI at that time, told the commission last May that many states have started to serve the mentally ill through managed care plans, and the "results have not been encouraging."
Yet when Leavitt announced in October that HHS had approved changes requested by New York State in its Medicaid program, he cited New York's "improved efficiencies from greater
reliance on managed care," which would allow the state to cover under Medicaid those individuals whose income would otherwise be too high to qualify them for the program.
In addition to concerns about the commission recommending greater reliance on managed care, Lea Ann Moricle, MD, a Maryland psychiatrist who appeared before the commission on behalf of both NAMI and the National Council for Community Behavioral Healthcare, expressed opposition to the use of excessively restrictive formularies as a means of controlling the cost of medications, "especially atypical antipsychotics used to treat schizophrenia and bipolar disorder."
She also expressed concern about importing into Medicaid the kinds of utilization review requirements that have proved time-consuming for psychiatrists dealing with the Medicare Part D program. "For example, why should a separate process be required to receive authorization for 2 different pill sizes of the same medication—ie, if a patient takes a 5-mg pill and a 10-mg pill of the same drug together?" she asked.