Herald-Leader Editorial

Steps toward better mental-health care; Congress, Kentucky have crucial opportunities

July 30, 2014 

In addition to already insuring more than 400,000 Kentuckians, the Affordable Care Act will also spark long-needed expansions in treatment for addiction and mental illness.

To make the most of this opportunity and begin healing many of Kentucky's desperate ills, a few things will have to happen:

■ Congress should provide more flexibility to use Medicaid dollars to open residential treatment facilities. Legislation was introduced earlier this month in the House to start unwinding an almost 40-year-restriction that was aimed at ending the warehousing of patients in institutions. Now the restriction is also blocking Medicaid support for drug- and mental-health residential recovery centers that have more than 16 beds.

The Breaking Addiction Act has 10 Democratic sponsors, including three from Ohio. As Rep. Hal Rogers, a leader in combating the prescription painkiller epidemic, knows all too well, addiction is bipartisan and has ravaged far too many Kentucky families and communities. Rogers and the other Kentucky Republicans should reach across the aisle on this reform, which would create a pilot program of eight to 10 states — one of which, we hope, would be Kentucky.

■ Kentucky must make sure that its own Medicaid managed-care contractors are not pulling the rug out from under fragile Kentuckians and the programs that serve them before more effective alternatives are in place.

The Courier-Journal's Mike Wynn recently reported that, in the last 18 months, 33 of Kentucky's roughly 50 therapeutic day programs have shut down, in large part because the for-profit companies that are managing Medicaid won't pay them or make it too burdensome to collect reimbursements.

The state is moving toward treatment approaches that rely less on segregated settings and have been shown by research to be more effective.

But abruptly ending a program that has helped stabilize individuals who have a mental illness and leaving them alone with nothing constructive to fill the hours is inviting relapse. While denying reimbursement may yield greater profits for the managed-care companies, it's a false economy that will ultimately cost the state more.

It would be a shame if short-sighted for-profit managed-care companies sabotage the opportunities created by Gov. Steve Beshear's embrace of health care reform.

As a result of the ACA, mental-health and substance-abuse treatment benefits are now available to a broad cross-section of people for the first time in Kentucky through Medicaid, the federal-state program that covers almost a quarter of the state's population.

Also, policies sold on Kynect, the state health-insurance exchange, include mental-health and substance-abuse treatment benefits. State scrutiny will also be required to make sure insurers honor those obligations.

The new revenue streams should encourage providers to open treatment programs and centers that will be accessible to all, growing the state's capacity to respond to behavioral health needs.

Kentucky has chronically underfunded mental health services, and few places have suffered more from the opioid epidemic and other substance abuse. The state can't afford to waste any of these new opportunities for recovery.

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