Nearly a quarter of the estimated 1.5 million uninsured Ohioans live with mental illness and would benefit from expanding Medicaid under the Patient Protection and Affordable Care Act, according to a report Thursday from the National Alliance on Mental Illness.
Only two states — Nebraska and Minnesota — have a higher percentage of uninsured adults living with mental illness, according to the report, which found the rate in both states exceeds 30 percent. Minnesota has adopted expansion. Nebraska has rejected it.
So far, 22 states have voted to expand Medicaid, with four leaning to expand, 13 leaning against expansion and 12 either unclear or undecided, according to the Center on Budget and Policy Priorities.
Ohio is among the states still undecided about expansion, which would extend Medicaid coverage to about 366,000 residents earning up to 138-percent of the federal poverty level, or about $32,000 annually for a family of four.
The federal government would pay the full cost of expansion for the first three years and at least 90 percent of Medicaid billing in subsequent years.
Gov. John Kasich has made Medicaid expansion a centerpiece in his state budget, but a Republican-led legislature took it out of the budget. Some conservative Republicans have concerns about accepting from the federal government an estimated $13 billion during the next seven years to pay for the expansion.
This week, a Republican bill was introduced to revive Kasich’s plan. But if expansion is ultimately rejected, Ohio could forfeit $53 billion in federal funding over the next 10 years, according to NAMI. Only Texas would give up more — $66 billion.
“Besides abandoning people in need, states that reject Medicaid expansion lose an opportunity for federal funds that would help strengthen the overall mental-health-care system,” said Michael Fitzpatrick, NAMI executive director.
Local mental health experts say failing to expand Medicaid would not only mean missing out on badly needed federal tax dollars, it would mean missing a rare opportunity to alleviate the tax burden for caring for the mentally ill.
Many uninsured Ohioans struggling with mental illness are also living in poverty or homeless and often do not receive help until after they are convicted of a crime, said Dr. Ryan Pierson, chief clinical officer at the Montgomery County Alcohol Drug Addiction and Mental Health Services Board.
The cost to incarcerate and treat mentally ill patients can be more than twice the cost of treatment alone, Pierson said.
“It’s a lot less expensive to actually pay for an individual’s care at the time that they need it as apposed to waiting for a crisis to occur,” he said.
Nationwide, about 2.7 million uninsured individuals living with mental illness would become eligible for health care under Medicaid expansion, according to NAMI.
Expanding Medicaid would also provide a safety net for mentally ill Ohioans who have already suffered cuts to federal funding for treatment programs and seen facilities closed, Pierson said.
The health care law calls for billions of dollars in cuts in Medicaid payments for treating the uninsured. Without an expansion of Medicaid to offset those cuts, “we’re going to see the real possibility of losing psychiatric care in our community,” Pierson said.
Passing on Medicaid expansion
Between 2013 and 2022, states in which Medicaid expansion is still pending stand to lose a total of $255 billion in federal funds if they reject it. Among the states undecided, Ohio, Texas and Tennesse would lose the most federal money during a 10-year period.
- Texas: $66 billion
- Ohio:$53 billion
- Tennessee: $23 billion
- Michigan: $18 billion
- Indiana:$17 billion
- South Carolina:$16 billion
- Virginia:$15 billion
- Arizona:$10 billion
- West Virginia:$9 billion
- Kansas:$5 billion
- Utah:$5 billion
- Maine:$3 billion
- Montana:$2 billion
- New Hampshire:$2 billion
Source: National Alliance on Mental Illness