AMHCA Testifies Before Congress on Medicaid Expansion, Counselor Coverage Under Medicare
By James K. Finley
Associate Executive Director and Director of Public Policy
AMHCA testified before the U.S. House Energy and Commerce Committee’s Oversight and Investigations panel on March 26, 2014. The panel was considering the adequacy of the nation’s hospital emergency department services for psychiatric patients.
AMHCA sought to redirect the hearing’s attention to the adequacy of prevention and early intervention services for those with behavioral health needs. AMHCA’s testimony, in particular focused on state Medicaid expansion and Medicare recognition of clinical mental health counselors and marriage and family therapists.
“Opportunities to testify before key congressional committees are rare, and witness slots are highly coveted by national advocacy organizations,” said Joel Miller, “so AMHCA is very pleased to have been invited to appear before a congressional committee.” Miller is AMHCA’s executive director & CEO.
AMHCA’s testimony stressed the importance of state Medicaid expansion programs in promoting health insurance coverage for uninsured people with mental illnesses as well as improved access to clinical mental health counselor services under Medicare.
AMHCA’s LaMarr Edgerson Spoke Forcefully on Behalf of AMHCA and CMHCs
AMHCA board member LaMarr Edgerson, PsyD, LMFT, NBCCH, represented AMHCA at the hearing and delivered the testimony. A clinical mental health counselor and licensed marriage and family therapist from New Mexico, Edgerson is also AMHCA’s director-at-large.
“The most significant barrier to accessing timely, effective, quality mental healthcare is the lack of continuous, robust health insurance coverage that provides comprehensive mental health benefits, from inpatient care services to prescription drugs to outpatient care to prevention programs,” Edgerson said.
Rep. G.K. Butterfield (D–N.C.) praised Edgerson’s testimony at the hearing as well as AMHCA’s report on Medicaid expansion, “Dashed Hopes, Broken Promises, More Despair,” which was issued in February.
Members of Congress Engaged and Responded to AMHCA’s Testimony
Essential health benefits are provided in health plans governed by the Affordable Care Act, the state Medicaid expansion, and Medicare programs. Senior committee member Rep. Diana DeGette (D–Colo.) discussed AMHCA’s findings on reduced state spending for mental health services and called for improved coverage and payments for mental health services.
Rep. Henry Waxman (D–Calif.) called the issue of Medicaid expansion described in AMHCA’s report as the “elephant in the room” that is causing nearly 4 million people with serious behavioral disorders to go without health insurance. He went on further to describe the major conclusions made in the “Dashed Hopes” report.
In fact, in a March 10 letter, Reps. Waxman and DeGette urged the committee chair to hold a hearing on the impact of states’ refusal to expand Medicaid coverage under the ACA, citing AMHCA’s “Dashed Hopes” report and its findings.
AMHCA’s testimony stressed that emergency department patients are encountering barriers such as lack of coverage or providers when they attempt to access services in the community, particularly for prevention, early intervention, and therapy. As a result, they end up using emergency departments for care when they reach a crisis.
Edgerson spoke forcefully for professional recognition, saying, “Clinical mental health counselors are primary mental health providers who offer high-quality, comprehensive, integrative, cost-effective services across the lifespan. They are uniquely qualified licensed clinicians trained to provide mental health assessment, prevention, diagnosis, and treatment.”
He urged further that Medicare mental health services be modernized to include newer providers, such as clinical mental health counselors and marriage and family therapists, as U.S. representatives Christopher Gibson (R–N.Y.) and Mike Thompson (D–Calif.) have proposed in HR.3662.
“Unconscionable” is the word Edgerson used to describe the decision by Congress not to reimburse CMHCs and LMFTs under Medicare and the decision by policymakers in half of the states not to accept Medicaid expansion as as well as a huge financial mistake. Those decisions, he said, deny health insurance coverage with comprehensive health and mental health services to the most vulnerable citizens—those with serious behavioral problems.
AMHCA’s testimony also noted that stable health insurance coverage is the passkey to cost-effective and timely mental health services in the United States. “Medicaid expansion can afford people with mental health diagnoses greatly expanded access to mental health and substance use treatment in an integrated and community-based setting, with a person-centered treatment focus,” Edgerson said.
The committee is expected to act shortly on legislation addressing issues related to access to inpatient care, but the early version of the legislation does not address the underlying causes of the access problems that AMHCA has urged the committee to remedy.
Psychiatric Bed Shortage Was Overarching Focus of Hearings
The hearing was titled, “Where Have All the Patients Gone? Examining the Psychiatric Bed Shortage.” The purpose of the hearing was “to explore the implications of the nationwide shortage in inpatient psychiatric beds, including the growing trend of patients requiring admission for psychiatric care being boarded for extended periods of time in emergency departments until an inpatient psychiatric bed becomes available,” according to a memo from the Committee on Energy and Commerce.
The memo said the hearing would also examine “the strain that this shortage exerts on the seriously mentally ill throughout our communities in the form of homelessness as well as increased contact with law enforcement.”
A clinical psychologist with 30 years of experience, Rep. Tim Murphy, PhD (R–Pa.), is the chairman of the House Energy and Commerce Subcommittee on Oversight & Investigations, and he convened the hearing. Other witnesses who testified along with Edgerson included:
- Lisa Ashley, parent of a son with serious mental illness, Sacramento, Calif.,
- Jeffrey L. Geller, MD, MPH, professor of psychiatry and director of Public Sector Psychiatry, University of Massachusetts Medical School, Worcester, Mass.,
- Jon Mark Hirshon, MD, MPH, PhD, FACEP, Task Force chair, 2014 American College of Emergency Physicians National Report Card on Emergency Care, associate professor, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Md.,
- Michael C. Biasotti, chief of police and past president of New York State Association of Chiefs of Police; parent of a daughter with serious mental illness, New Windsor, N.Y.,
- Thomas J. Dart, sheriff, Cook County Sheriff’s Office, Chicago, Ill.,
- Steve Leifman, associate administrative judge, Miami-Dade County Court, Eleventh Judicial Circuit of Florida, Miami, Fla.,
- Gunther Stern, executive director, George-town Ministry Center, Washington, D.C.,
- Hakeem Rahim, speaker and mental health educator and advocate, Hempstead, N.Y., and
- Arthur C. Evans Jr., PhD, commissioner, Department of Behavioral Health and Intellectual disAbility Services and University of Pennsylvania, Philadelphia, Pa.
“We had very little notice to prepare for the hearing, but it was really worth it,” said Renee Kreithen, AMHCA’s director of chapter relations, communications, and Diplomate program. “AMHCA is definitely on the map now.”