Category: Medicaid

THE VA AND MEDICAID COGNITIVE DISABILITY

1/20/2021

[P.S. OLMSTEAD ISN'T LIMITED TO MEDICAID]

In 2021, a lot of Americans have someone in their family or know someone or are someone with:

Mental Illness
Brain Injury
Substance Issues
ADHD, and/or
Autism

Some or all of those issues are also seen in the military.
When we think about the budget for the VA or Medicaid Services for people with cognitive disability --- IT'S HUGE and it's often not adequate.
Ultimately, Research is going to be the answer.

Meanwhile . . .
We need some re-allocation of financial and human resources.

We need a huge investment in Translational Research & Medicine
- This is an issue for Medicine across the board but it is a huge, ethical and moral issue in cognitive disability
- This is an issue for Criminal Justice which in the US and many countries is the Cognitive Disability Provider of Last Resort

We must get HONEST about the NEED and bring housing, placements and services to SCALE.

Whether we want to call it "DEFUNDING THE POLICE" or "RE-ALLOCATING THE POLICE" those LAW ENFORCEMENT ROLES are in need of MAJOR TRANSFORMATION.

US Department of Justice

13. What must a public entity show to establish a fundamental alteration defense based on an Olmstead plan?

A: A public entity raising a fundamental alteration defense based on an Olmstead plan must show that it has developed a comprehensive, effectively working Olmstead plan that meets the standards described above, and that it is implementing the plan.

A public entity that cannot show it has and is implementing a working plan will not be able to prove that it is already making sufficient progress in complying with the integration mandate and that the requested relief would so disrupt the implementation of the plan as to cause a fundamental alteration.

Integration of Community & Institutional Mental Health Policy @ the Federal & State Levels with Corresponding Appropriations to Deal with Decades of Neglect

1/20/2018

I'm really glad people are taking the Opioid Crisis seriously. We're beginning to address the Crisis in Mental Health as well as the Criminal Justice System -- BUT there is a LONG, LONG WAY TO GO.
With respect to Mental Health --- it has been a pretty WILD RIDE.
I think we are primed for a more BALANCED and INTEGRATED MENTAL HEALTH POLICY than we ever have been before.
We've mentioned this before that we seem on the CUSP of a CONSENSUS when it comes to Mental Health Policy among what have historically been warring views across the Mental Health & Disability Advocacy Spectrums.
We "think" a CONSENSUS "might" look like this:

Requirements to continuously update data and analysis on the need for:
- Housing
- Appropriate Community Mental Health Treatments, Including Intensive Community Treatments such as Assertive Community Treatment;
- Institutional Care
Get rid of the Institute for Mental Disease Exclusionary Rule or IMD Rule and fully Incorporate the Institutions into the State's Olmstead Planning Process.
Allow Medicaid to Cover Housing for people needing Long Term Care

There was a BIG PUSH in 2015 to persuade Medicaid to cover Housing. Advocates and for that matter even States were rightly chanting a mantra of "Housing is Healthcare."

Well what Medicaid did was that it said it would fund a lot of peripheral services around Housing -- BUT NOT THE HOUSING.

Ironically what CMS did do was remind States of their responsibilities under OLMSTEAD. -- YEAH!

BUT Olmstead isn't being enforced the way it should be and States are pretty cavalierly resistant to this DISABILITY CIVIL RIGHTS LAW in no small measure because of the Housing Liability.

AND who should be caught in the middle: People with Significant Disabilities.

So the BOTTOM LINE is we don't care who pays for adequate Housing, Services, and Institutional Care -- BUT some governmental entity needs to pay for it. The State has a LEGAL DUTY to either provide all this or have a plan to do it for the Housing & Community Services and in Colorado with respect to inmates needing Competency Exams -- the State is under a Settlement Agreement.

Now because we have been neglecting this for DECADES -- we do need to JUMP START it with major appropriations. From both the Feds and the States.

MAYBE If we're NOT FIGHTING with each other and working together to get the Scale of Housing, Services, and Institutional Care we need-- we might get it.

In the meantime, I will be contacting the State to let them know they have until Thursday January 25, 2017 to get back with me on Parity and ACT to try to work something out otherwise I will be complaining to CMS REGION 8.

CMS -- Coverage of Housing-Related Activities -- June 26, 2015

Housing: A Conundrum for the States -- A Nightmare for People with Mental Illness

Medicaid's Institute for Mental Disease Rule, Olmstead, Parity, & CMS/ HUD Enforcement--Some Motivational Therapy & Incentives So States Will Stop Hurting People with Mental Illness & Comply with the Law

1/18/2018

Whether its Individuals, Corporations, Governmental Entities or whoever -- Lying generally takes place where people are afraid.
At bottom, we think States are just "AFRAID" they don't have the resources for the Scale of the Problem when it comes to the Housing and Service Needs of people who are institutionalized or at great risk of institutionalization..
We are running into a lot of MORAL HAZARDS where almost 20 years after Olmstead it is pretty acceptable behavior among the States to claim they are complying whether they are or not. The vast majority are not, including Colorado.
Unlike a State like Mississippi, Colorado is a rich State BUT the political realities of TABOR are not leading to an abundance of HONESTY, even though theoretically Olmstead and Parity as Federal Law TRUMP TABOR.
You can see TABOR's affect in Governor Hickenlooper's really very well-intentioned "State Comprehensive Behavioral Health Care Plan" -- that is NOT an Olmstead Plan -- but focuses on trying to make Behavioral Health more "efficient" -- which is not a bad thing and it's a smart thing to do.
BUT we're still not complying with the Law. Most states aren't either.
Our proposal would be to Lift the Medicaid IMD Rule for those States that have and are implementing a State Olmstead Plan with:

Measurable Goals
Reasonable Time Frames, and
Funding to Support the Plan

---The Plan must be designed to bring Housing & Services to Scale to Meet the Need.
---Specifically include assessment for Intensive Community Mental Health Services, including Assertive Community Treatment and planning.
---Comply with Parity
---Continuously Updated; and
---Inclusive of the Disability Community

Of course, this doesn't really require anything States shouldn't already be doing -- BUT they're not doing it.

The Institute for Mental Disease Rule or IMD Rule under Medicaid was really designed to "incentivize" States to provide Intensive Community Mental Health Services, including small housing situations by refusing to fund "Institutes" of 16 beds or more in which a majority of the residents had mental illness.

Well, that didn't work -- the States didn't put the money in Institutions but they didn't adequately fund Intensive Community Mental Health needs either.

Further, we're going to need some ENFORCEMENT on this -- we sure as hell can't rely on the States to police themselves.

There needs to be provision for Administrative Enforcement through the Centers for Medicare & Medicaid Services (CMS) as well as HUD (US Dept. for Urban Development).

The Scale of these Problems is HUGE and Complex -- BUT we can't continue to allow the LAWLESSNESS of the STATES when it comes to FEDERAL DISABILITY CIVIL RIGHTS LAW.

We think lifting of the Medicaid IMD Rule for States that Comply with Olmstead & Parity and that is Administratively Enforced through CMS & HUD could bring some BALANCE to an OUT-OF-BALANCE SYSTEM(s) that is HURTING A WHOLE LOT OF PEOPLE.

Lois Curtis -- one of the original Plaintiffs of the 1999 US Supreme Court Olmstead Decision, holding that unnecessary institutionalization of people with disabilities amounted to Discrimination and Violated Title II of the Americans with Disabilities Act (ADA).

Medicaid & the IMD Rule (Resources)

Medicaid Is A Mixed Bag And It Is NOT Some Innocent By-Stander in the Current Mental Health Crisis whether in Colorado or the Rest of the Country

1/17/2018

We're going to pick-apart Jaffe's summarized analysis of Medicaid's role in the current crisis and suggest why both Conservative and Liberal Mental Health Advocates have plenty to fear from Medicaid Mental Health and the States who administer the State Medicaid Programs.

With regard to "anti-psychotics," historically people and professionals including advocates thought they were going to work a lot better across the board than they did. So they were a HUGE part of de-institutionalization and the community mental health movement.
NOW -- we recognize that "genetic testing" may be really necessary to decide which medications are best. Further, a lot of these medications work on the brain globally and not on individual neural circuits and that is probably not a good thing, according to Cal-Tech neuroscientist David Anderson.
Further our whole understanding of "mental illness" is changing to something much more related to the brain, the gut and "immune system" than it was before. So the point being, we don't have a complete and comprehensive understanding of "mental illness" and and we're very slow to change incorrect old ideas.
So if you thought "anti-psychotics" were going to solve all these problems and "medication adherence" you probably didn't think you needed a lot in Community Mental Health and Medicaid Mental Health.
50 Years on or So -- SURPRISE! People with mental issues need a lot more than medication, the medication is more complicated than advertised, and "Medication Adherence" requires a competent profession and one that listens to its patients. We are lacking in both.
You just can't be a viable medical/healthcare profession and rely on outdated science like the DSM 5. Mental health professionals are NOT paid as much because they are NOT worth as much. Hopefully, the integration of physical and mental health which is so desperately needed in mental health will help both people with mental illness and the mental health profession raise its standards and its salaries.
So Medicaid is a BIG PART of that integration of physical and mental health care AND they deserve A LOT of credit for that.
BUT what happened when we realized "anti-psychotics" weren't going to be enough? We rushed right in to fund effective and expensive intensive community mental health treatments like -- Assertive Community Treatment, right?
HELL NO! We let the jails, prisons, homeless shelters and streets handle the intensive treatment needs.
This has gotten pretty nightmarish and Orwellian in Colorado where the State won't even answer a question whether it has an objection to a "waitlist" for ACT.
BUT now we're supposed to have Medicaid Parity, and the State continues to fail to fund this treatment as it would a medical/surgical treatment.
So it is this INTENSE STATE RESISTANCE to adequately fund Intensive Community Mental Health Treatments on par with medical treatments that led to:
- the Mental Health Crisis;
- Calls to get rid of the Institute for Mental Disease [IMD] Rule in Medicaid;
- AND a Call to a Return to Asylums
When State Medicaid Programs like Colorado's Resist the Large Funding Needs of People with Serious Mental Illness -- They Are Also Violating the Law & Civil Rights of Thousands of Coloradans with Mental Illness who are Homeless and Incarcerated.

From "Insane Consequences" . . .

"In spite of common lore, it is Medicaid, more than the advent of anti-psychotics and tranquilizers, or the construction of community mental health centers, that caused and continues to cause "de-institutionalization."

"The overall effect of exclusion [Medicaid's exclusion of payment for Institutes of Mental Disease] has been to create incentives or states to move patients out of state hospitals, which has contributed to homelessness and inappropriate incarceration."

See page 187 of the book.

See the Caption below for Colorado's Version of the Orwellian Nightmare

The Orwellian Nightmare is in one instance the Dominance of Irrational Political Concepts. Kind of like Colorado Medicaid's Refusal to Provide Assertive Community Treatment where "Reasonably Medically Necessary" Helps Coloradans with the most serious community mental health needs. Perhaps most distressing, the Orwellian practice of the Hickenlooper Administrations confusing politeness and cordiality with good faith and complying with the law.

The ACA vs. Medicaid As A Provider of Community Living Services Sometimes With A Large Need For Intensive Services

8/12/2017

Well, I have certainly wondered whether the implementation of the ACA (Affordable Care Act) in Colorado hurt the implementation of Intensive behavioral health services in Colorado.
   I'm generally a fan of the ACA, I'm not a fan of Colorado's really long history of under-funding intensive community mental health services such as Assertive Community Treatment (ACT).
   Some candidates for Governor are suggesting Medicaid should be reserved for people with disabilities. We really do want everyone's needs addressed and we certainly don't think people with significant mental health needs are getting their needs adequately addressed.
   I am concerned that there "may" be a lot more focus on increasing the Medicaid rolls with not enough thought to providing the intensive community services that people with significant mental health disabilities need to prevent homelessness and/or incarceration.
While I think the Behavior Health/Criminal Justice Plan group the Governor established should get at some of this, there has been a lot of State resistance to looking at mental health issues and service needs from an Olmstead perspective with advocates and peers as well as others.
Further, Olmstead really is focused on those folks with disabilities who are institutionalized or at risk of institutionalization -- and where the State has a real legal obligation.

Denver Post

Is Medicaid gobbling up Colorado’s budget?

Examining an argument from the Colorado gubernatorial campaign

http://www.denverpost.com/2017/08/11/medicaid-affordable-care-act-colorado-budget/

OHIO'S GOV. KASICH & THE HICKENLOOPER ADMINSTRATION UNDERSTAND PEOPLE NEED MEDICAID

7/2/2017

John Kasich, Republican Governor of Ohio, said on "This Week" on ABC that people with mental illness can't stay in jails or on the streets -- just think if it were yourself -- it's obvious.
So we're really reaching a consensus about this issue and a lot of States are working on it, including Colorado and the Hickenlooper Administration.
But what is one of the keys to fixing all this -- MEDICAID. Kasich's point was we won't be able to deal with the problem of people with mental illness in jails or the opioid epidemic if we cut Medicaid.
Earlier I had listened to "Washington Week" on PBS in which one of the journalists pointed out that Americans don't go to the doctor more -- we just pay more for it.
I don't think anybody disagrees that healthcare needs to be reformed.
There are a lot of systemic reforms that need to be made.
But anything such as the Senate Healthcare Bill that makes it harder for the State to provide for the needs of people with mental illness who are already suffering horribly under the current system --- well, we strenuously oppose.

DAMN IT -- WE NEED PEOPLE OUT OF THE CRIMINAL JUSTICE SYSTEM -- WITH ALL APPROPRIATE SERVICES & SAFETY PROTOCOLS --- NOW ---- & AS FAR AS I KNOW THAT MEANS MEDICAID

11/1/2014

We can't wait any longer, people are dying AND saying we're now not going to subject people with mental illness to "administrative segregation" is NOT near enough.
The misguided idea that we can subject people with "mental illness," brain injury, neurological disease or developmental disability to further emotional trauma to obtain some penological goal is in itself delusional and not based on any evidence that I am aware of.
We need to be able to ramp up the CO Medicaid Community Mental Health Services Waiver that has struggled and struggled to be relevant to the actual needs of people with "mental illness."
( For more "insight" see our Instructive Comparison of the HCBS-EBD Waiver & the HCBS-CMHS Waiver)
At the top of the list --- Assertive Community Treatment (ACT) and ULTRA Intensive Case Management -- on a daily basis if necessary. And if we are really smart "housing as healthcare."
WE CAN DO THIS & WE NEED TO DO IT NOW!

Let's Start Costing It Out NOW for this Upcoming Legislative Session.
Some of the Intended Benefits:

Terminating the practice of putting people with bad behaviors in torture chambers (aka modern prisons & jails) to "teach them a lesson."
Terminating the practice of scapegoating people from jailors to judges in impossible positions with inadequate alternatives and training.
Achieving greater community safety than what we currently have.

Research reveals that get-tough tactics may worsen rates of juvenile delinquency
http://www.scientificamerican.com/article/how-to-turn-around-troubled-teens/

to go back to top^

Val's Blog

THE VA AND MEDICAID COGNITIVE DISABILITY

Integration of Community & Institutional Mental Health Policy @ the Federal & State Levels with Corresponding Appropriations to Deal with Decades of Neglect

Medicaid's Institute for Mental Disease Rule, Olmstead, Parity, & CMS/ HUD Enforcement--Some Motivational Therapy & Incentives So States Will Stop Hurting People with Mental Illness & Comply with the Law

Medicaid Is A Mixed Bag And It Is NOT Some Innocent By-Stander in the Current Mental Health Crisis whether in Colorado or the Rest of the Country

See the Caption below for Colorado's Version of the Orwellian Nightmare

The ACA vs. Medicaid As A Provider of Community Living Services Sometimes With A Large Need For Intensive Services

Denver Post

Is Medicaid gobbling up Colorado’s budget?

Examining an argument from the Colorado gubernatorial campaign

http://www.denverpost.com/2017/08/11/medicaid-affordable-care-act-colorado-budget/

OHIO'S GOV. KASICH & THE HICKENLOOPER ADMINSTRATION UNDERSTAND PEOPLE NEED MEDICAID

DAMN IT -- WE NEED PEOPLE OUT OF THE CRIMINAL JUSTICE SYSTEM -- WITH ALL APPROPRIATE SERVICES & SAFETY PROTOCOLS --- NOW ---- & AS FAR AS I KNOW THAT MEANS MEDICAID

Author

Archives

Categories

Val's Blog

THE VA AND MEDICAID COGNITIVE DISABILITY

Integration of Community & Institutional Mental Health Policy @ the Federal & State Levels with Corresponding Appropriations to Deal with Decades of Neglect

Medicaid's Institute for Mental Disease Rule, Olmstead, Parity, & CMS/ HUD Enforcement--Some Motivational Therapy & Incentives So States Will Stop Hurting People with Mental Illness & Comply with the Law

Medicaid Is A Mixed Bag And It Is NOT Some Innocent By-Stander in the Current Mental Health Crisis whether in Colorado or the Rest of the Country

See the Caption below for Colorado's Version of the Orwellian Nightmare

The ACA vs. Medicaid As A Provider of Community Living Services Sometimes With A Large Need For Intensive Services

Denver Post​Is Medicaid gobbling up Colorado’s budget?Examining an argument from the Colorado gubernatorial campaign​http://www.denverpost.com/2017/08/11/medicaid-affordable-care-act-colorado-budget/

OHIO'S GOV. KASICH & THE HICKENLOOPER ADMINSTRATION UNDERSTAND PEOPLE NEED MEDICAID

DAMN IT -- WE NEED PEOPLE OUT OF THE CRIMINAL JUSTICE SYSTEM -- WITH ALL APPROPRIATE SERVICES & SAFETY PROTOCOLS --- NOW ---- & AS FAR AS I KNOW THAT MEANS MEDICAID

Author

Archives

Categories

Denver Post

Is Medicaid gobbling up Colorado’s budget?

Examining an argument from the Colorado gubernatorial campaign

http://www.denverpost.com/2017/08/11/medicaid-affordable-care-act-colorado-budget/