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Medicaid cuts in health bill threaten mental health care for Floridians (Miami Herald)

Daniel Chang of the Miami Herald writes:

“Before Haylee Kalick signed up for Medicaid in 2015, she had been involuntarily committed to hospital psychiatric wards under Florida’s Baker Act close to 20 times, said her father, Bruce Kalick. He was the one who had to call police when his daughter swallowed a bottle of pills and when she cut her wrists with a knife.

But ever since Haylee Kalick signed up for Medicaid, the public health insurance program for low-income and disabled Americans, she has been able to receive the multiple prescription drugs, weekly counseling sessions and monthly psychiatric therapy necessary to manage conditions that include Tourette Syndrome, bipolar disorder and obsessive compulsive disorder.

‘Medicaid literally saved her life,’ Bruce Kalick said.

Now, he fears that his daughter’s recovery could be short-circuited by Congress’ efforts to repeal and replace the Affordable Care Act, also known as Obamacare.

Bills in the House and Senate propose deep cuts to Medicaid funding — cuts that could reduce or eliminate the mental health services that Haylee Kalick relies on to keep her from spiraling back into a pattern of blackouts, attempts at suicide, and involuntary commitments in psychiatric institutions.

‘She’s so afraid of going in those places,’ Kalick said of the psychiatric hospitals where his daughter has been committed. ‘She comes out worse.’

These days, Haylee Kalick, 21, no longer thinks of taking her own life, or of hurting others. And she can envision herself as a wife and mother, with a career.

‘I see a future where I’m married and have kids, and I can lead a normal life, a happy life,’ she said, as she reclined in an easy chair in the den of her grandparents’ apartment in Weston. ‘I want to be happy.’

Like Haylee, more than 350,000 Floridians relied on Medicaid for behavioral health services, which includes mental health and substance abuse treatment, in 2015 and 2016 at a cost of about $400 million, according to the state’s Agency for Health Care Administration.

That ranks Florida’s Medicaid program near the bottom of all states in behavioral health spending, said Anne Swerlick, an attorney and analyst for the Florida Policy Institute, a nonprofit that examines state policy impacts on the economy [emphasis added].

Because Florida ranks low in spending for Medicaid in general, an average of $5,864 per enrolled person, Swerlick said state legislators could be forced to make drastic cuts to the program under the proposal passed by the U.S. House of Representatives, called the American Health Care Act, and the bill currently in the Senate, known as the Better Care Reconciliation Act.

Both bills call for spending limits — known as ‘per capita caps’ — for each person enrolled in Medicaid, with annual adjustments for medical inflation. Caps would be calculated based on each state’s historical Medicaid expenditures, and any amount spent above the cap would be entirely at the state’s expense.

‘This would make a bad situation worse,’ Swerlick said.

Under its current structure, Medicaid spending is unlimited, with the federal government providing 61 cents of every dollar that Florida spends to fund the program.

Swerlick said that under a Medicaid spending cap, mental health is likely to be targeted for budget cuts because it’s considered an optional benefit for adults under federal Medicaid rules. Federal law makes certain medical care mandatory under Medicaid, such as hospitalization and nursing home coverage.”

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