The Los Angeles County Board of Supervisors unanimously passed a motion by Supervisors Kathryn Barger and Hilda L. Solis at its Feb. 5 meeting to urge the state of California to apply for a Section 1115 Medicaid waiver that would expand coverage for inpatient mental health treatment.
“Medicaid is the largest payer of mental health services and expansion of this coverage would be critical to those who are in need of treatment,” Supervisor Barger said in a statement. “It is imperative that we use this opportunity to demonstrate that mental health treatment should be a permanent and ongoing priority that is worthy of both federal and state investments.”
According to the supervisors’ motion Medicaid is the largest source of funding for mental health and substance use disorder services, However, the federal Institutions for Mental Disease exclusion rule prohibits states from using Medicaid funds for inpatient residents of an IMD who are between the ages of 21 to 64.
An IMD is described as “a hospital, nursing facility, or other institution of more than 16 beds that is primarily focused on treating mental illness, including alcohol and substance abuse disorders,” the motion stated.
“Prior to the creation of a the Medicaid program, inpatient psychiatric care was funded by the states. The intent of the IMD exclusion was to prevent states from shifting the responsibility and cost of inpatient psychiatric care to the federal government via the Medicaid program,” the motion states. “However, over the years states have demonstrated that they are unable to provide adequate coverage and access for a significant number of low-income individuals with chronic and severe mental illnesses that are in need of psychiatric hospitalization.”
Under Section 1115 of the Social Security Act, the U.S. Secretary of Health and Human Services has the authority to waive specific provisions of health and welfare programs such as Medicaid. The waiver, which is generally approved in five-year intervals, had not previously been available to address the gap in inpatient mental health coverage created by the IMD exclusion until last year, the motion stated.
In November, the Centers for Medicaid and Medicare Services announced that for the first time, the federal government would begin to consider state applications for an IMD exclusion waiver. This would provide Medicaid coverage for IMD treatment to those who suffer from a severe mental illness.
“Last week, this board voted unanimously on Supervisor Barger’s previous motion to develop a countywide plan to expand our inpatient and stepdown mental health beds,” Dr. Jonathan Sherin, director of the Department of Mental Health, said in a statement. “Today’s motion is complementary to our existing efforts, and will allow us to right-size our network of hospital beds to ensure that the right level of care is delivered to those in need — including not just mental health services, but also services for addictions and medical comorbidities.”
The supervisor’s motion directs the county CEO to send a five-signature letter to Governor Gavin Newsom, the California Department of Health Care Services, and the Los Angeles County State Legislative Delegation urging the state to apply for the 1115 Medicaid waiver to allow for the expansion of Medicaid coverage to the excluded population who are in need of inpatient mental health treatment.
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