Austin Mayor Steve Adler joined mayors across the country in drawing attention to mental health as part of the National Mayors' Mental Health Day of Action on Wednesday. He called on Congress to protect mental health services in the American Health Care Act, which, if passed in its current state, would leave many people without access to mental health care in Travis County.
“Our community is so much stronger when everyone has access to the tools and the support that they need, so that everybody can contribute to their fullest potential to our city and to our community,” Adler said.
Earlier on Wednesday, the Congressional Budget Office released its review of the GOP's health care bill. It found that the bill, which is meant to replace the Affordable Care Act, would cut more than $800 billion from Medicaid, the federal insurance program for low-income adults, children and people with disabilities. The bill would also remove provisions in the ACA that require private insurers to cover mental health services as part of essential health services.
Medicaid is the largest source of funding for mental health services in the U.S., according to Ellen Richards, chief strategy officer for Travis County Integral Care.
“The majority of our clients are on Medicaid and that creates access to a wide range of services," she said, "the most important of which are ongoing counseling and medication treatment supports that help people seek recovery from mental health issues and substance abuse disorders."
Integral Care treats patients regardless of their ability to pay, thanks to grants from the city, county and state. The combination of this funding and coverage for mental health services under the ACA allowed it to serve more than 24,000 people last year. Medicaid amounts to about $11 million of Integral Care's budget this fiscal year. Changes to Medicaid and mental health provisions in the new health care bill, Richards said, will mean people who can’t pay out of pocket for mental health services will end up losing access to care.
“Capping or cutting services will result in less or no access to care and longer waits for services," she said, "and this could be in the form of removing essential benefits from health plans and it could be cuts and caps to Medicaid."
Failing to address mental illness can lead to costly outcomes that fall to the city to cover, according to Karen Ranus, executive director of the Austin branch of the National Alliance on Mental Illness.
“Untreated mental health issues can lead people to homelessness, to lack of employment, to end up in the criminal justice system,” she said.
Ranus points to a federal waiver program that draws on Medicaid funding as proof of Integral Care’s success in combating these sorts of outcomes in recent years. The program allows Integral Care to partner with the police and emergency medical services in Austin.
“Between May 2014, as of October of 2016, we’ve diverted 1,600 people from jail in collaboration with APD," said Kim Macakiage, director of the 1115 waiver program at Integral Care. "We’ve diverted another 1,100 people from the ER with EMS. And an ER visit can cost up to $1,200 per person."
Programs like this one contribute to a strong mental health safety net in Austin, Ranus said, but she fears cuts to Medicaid will weaken it.
“I am hopeful that that will continue and that together we will find a way to complete those gaps, but at the end of the day, funding is funding, and when you lose funding those are really challenging gaps to address even when you've got a collaborative effort,” she said.
The City of Austin currently funds 12 local mental health service providers. Integral Care received more than $3 million from the city last year.