The federal rule that's hurting people with mental illness
With the stroke of a pen, President Lyndon B. Johnson expanded health-care coverage for tens of millions of Americans when he signed the Social Security Amendments of 1965, which created Medicare and Medicaid. But buried within this landmark legislation was a rule that sealed the fate of millions of people living with serious mental illness, relegating many to live in jails, prisons, shelters, or on the streets.
The so-called Institutions of Mental Disease rule, or “IMD” rule, prohibits Medicaid payments to psychiatric hospitals or other residential treatment facilities that have more than 16 beds and that treat patients aged 21 through 64. Medicaid reimbursement is the primary way for healthcare providers to offer services for uninsured and underinsured patients.
If the goal of the IMD rule was to accelerate the closure of long-term-care facilities and psychiatric beds in the United States, it was a spectacular success. According to a 2016 survey by the Treatment Advocacy Center, our country experienced a 96.5% drop in state hospital beds from peak hospital numbers in the 1950s. We have fewer psychiatric beds per capita than we did in 1850.
The actual intention was to shift mental health services to community-based, outpatient treatment programs. While many quality outpatient programs exist today, the reality is that for millions of the poorest Americans, this translated into no treatment at all. People living with serious mental illness are not guaranteed the help they need, resulting in needless suffering and harm. This is one reason why half the population of Rikers Island has received ongoing services for a mental illness during their jail stay. People with untreated serious mental illness comprise an estimated one-third of the total homeless population in the United States.
https://www.nydailynews.com/opinion/ny-oped-federal-rule-mental-illness-20220529-pjjl4pbrtrh4polv4tibnhis3y-story.html
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