Funding disparity for treating mental, physical illness unjust
For Jennifer Hoff, disparity in medical treatment for severe mental illnesses in the Medi-Cal system, compared with, say, heart disease or diabetes, can be seen in the face of her 21-year-old son, Matthew, who sits in an 8-by-13-foot cell at Calipatria State Prison. He is serving a 14year sentence for felony robbery.
“When my son turned 18, he was given a plane ticket and his shoelaces, and returned (from a residential psychiatric care facility in Montana) to the streets of Orange County to ‘direct his own care,’ ” said Hoff, who traveled to Sacramento recently to take part in the first “Right2Treatment” rally held at the state Capitol. “He doesn’t believe he is sick so, of course, he ends up on the street. My beautiful boy has the words ‘Crazy Boy’ tattooed across his face, yet they tell me he isn’t sick enough (to be placed on a psychiatric hold). Now, he’s sitting in prison because he walked into a BofA with a sticky note demanding $1,000, after getting drunk and deciding he wanted to leave town.”
Being mentally ill and psychotic at the time of the commission of such a crime is not a mitigating factor, Hoff said, except in capital cases. In Matt’s case, his public defender did not bring up either his illness or his intoxication.
“Matt was seen as just another ‘violent offender,’ ” Hoff said, “instead of this being what it was — an (access to mental health care) issue.”
Matt Hoff is one of roughly 600,000 adults in California receiving Supplemental Security Income and Medi-Cal — the state-federal health insurance program for the poor.
Matt was first diagnosed with schizoaffective disorder and bipolar disorder when he was 7 years old, and later, because of the severity of his symptoms and the lack of treatment facilities in California, his parents moved him to a residential treatment facility in Montana. He lived there from age 12 to 18.
But when he returned to Orange County, his mom said, things quickly deteriorated. Within six months, he was arrested for “sticking up” a Subway sandwich shop, that is, demanding money and food. He served time, and then reoffended with the BofA robbery.
Matt did not have a weapon, only a threat that he’d “blow the place up” if his demand wasn’t met.
But in California, if you “instill fear” in another human being for a perceived loss of life during the commission of a crime, Hoff explained, it will bump the charges up to a felony, even if you do not have the means to carry out the threat.
Hoff has joined dozens of other parents, siblings, spouses and providers in the mental health field in calling for a “Right2Treatment” — shorthand for four key changes that advocates say are needed for Medi-Cal beneficiaries with serious mental illnesses: (1) Enforce parity. (2) Integrate mental health care with mainstream physical health care as the Affordable Care Act calls for.
(3) Create uniform standards of care statewide, county to county.
(4) Establish accountability that those standards are being met.
“We’re refusing to pay for the sickest,” Hoff continued. “Those disabled by their illness find themselves lost in a world that denies the reality of a biological disease and offers talk therapy over intensive psychiatric treatment. It is a world that has laws allowing sick people to live in the street until they die in the gutter.”
A state policy of discrimination
Disparity of care exists on at least two levels for Medi-Cal recipients with serious mental illnesses, critics contend.
The first is in the failure to provide coverage as defined in the federal Mental Health Parity and Addiction Equity Act of 2008, which mandates that deductibles and co-pays and limitations that apply to physical illness treatment apply equally to mental health and substance-use disorder benefits.
Perhaps most glaringly, note critics, is that the state will not pay its full match of the federal Medicaid funds for “medically necessary” treatment of mental illnesses. While the federal government does not limit what it will pay for Medi-Cal mental illness claims, the state does. California caps the funding by budgeting only a fixed amount.
There is no cap on the amount that the federal government will pay for its 50 percent share of “medically necessary” treatment of physical and mental illnesses for Medi-Cal beneficiaries, according to the Centers for Medicaid and Medicare Services.
California does not “cap” the amount of Medi-Cal money for qualified “medically necessary treatment” of physical illnesses. It does for mental illnesses.
California’s share is paid for from a separate pot of money from vehicle license fees and a portion of the state sales tax. Most Medi-Cal recipients receive their mental health care through county mental health programs. The amount available to each of the counties depends on how much the economy generates. The amount available does not relate to caseload or the