Another Red State Moves toward Medicaid Expansion

A happy byproduct of the tortured debate about the Affordable Health Care Act is recognition of the benefits of Medicaid expansion.

Republican Sens. Rob Portman of Ohio, Shelley Moore Capito of West Virginia, Cory Gardner of Colorado and Lisa Murkowski of Alaska wrote in a letter to Majority Leader Mitch McConnell. “We are concerned that any poorly implemented or poorly timed change in the current funding structure in Medicaid could result in a reduction in access to life-saving health care services,”

Less than a week after the demise of the Trump/Ryan bill, the Kansas legislature voted to accept Medicaid expansion funds.  Here is an excerpt from the Washington Post story on March 29 covering the event.  

TOPEKA, Kan. — “State lawmakers in this deep-red state on Tuesday did what a year ago would have been unthinkable: They voted to expand Medicaid under the health-care law that Republicans here have railed against for years.

Among them was Sen. Barbara Bollier (R), whose support last year for extending the government health program to more poor Kansans was considered so rogue that her colleagues tossed her off a health committee. This month, so many Kansas lawmakers voted for the expansion that they nearly mustered the two-thirds majority needed to block the Republican governor’s expected veto.

The abrupt reversal in Kansas could be the front edge of a larger shift nationally, as state lawmakers absorb the repercussions of congressional Republicans’ failed attempt to repeal and replace elements of the Affordable Care Act.  (My bolding)

In Virginia, Gov. Terry Mc­Auliffe (D) on Monday pledged to revive efforts in his state’s Republican-led legislature to pass Medicaid expansion. Georgia’s Republican governor, Nathan Deal, also announced plans to change his state’s Medicaid program. Medicaid advocates in North Carolina see hope for renewed momentum as Gov. Roy Cooper (D) has sought to expand the program there through executive action.”

JAMA, journal of the American Medical Association, reported that 67% of Republicans, 79% of Independents, and 90% of Democrats supported the statement that “States may chose to expand Medicaid.”

If Kansas can do it, why not Wisconsin?  Some Republican governors and legislatures gradually moved to accept Medicaid expansion money after passage of the AHCA.  More are headed in that direction.  The evidence is clear that the federal funds save state dollars and help people who need it.

NOTE:  Maine voters will be able to support Medicaid expansion at the ballot box next November.  A petition drive to put the issue on the ballot succeeded in February.   Maine has a Republican governor who refused expansion funds.

UPDATE:  Click here for “The States where Obama’s Footprint Might Get Even Bigger.”

UPDATE: Click here to read a less hopeful report on prospects for change.  It is “No Obama Ceasefire in Red States.”

UPDATE:  Click here for a detailed report by NPR of what’s happening with Medicaid expansion in Kansas, Virginia, and Maine.

UPDATE:  Kansas legislature failed to override the governor’s veto.  A majority of the Republican-controlled legislature voted for expansion, but the measure failed by 3 votes because a 2/3 vote was required to override.



Judge Candidate Jill Karofsky Supports Mental Health Law Court…and She Won!

The Wisconsin State Journal endorsed Jill Karofsky in her bid to become Branch 12 District Court Judge.  The editorial board included this language in its endorsement.

“Karofsky will have a shorter learning curve in the job. And her experience provides more insight into how to improve court operations.  For example, [she] cites bias in bail-setting hearings as a key contributor to racial disparities in Dane County courts.  She also speaks with authority on the need for a special court to handle cases involving people with mental illness.”   Click here to read the endorsement.

Karofsky is running against Marilyn Townsend.  Both candidates met with the editorial board of the WSJ and replied to questions submitted by the Dane County League of Women Voters.  In her response to the League’s questions, Karofsky again mentioned her support for mental health law courts.  Here is her reply to a question about the disproportionate rate of incarceration of minorities.

“Judges should support, encourage and help develop alternatives to incarceration such as treatment alternative and diversion programs and specialty courts. These alternatives not only reduce incarceration rates but they have proven to reduce recidivism by addressing alcohol and other drug addiction and mental illness. In addition, at-risk youth in our community must be linked to positive connections and mentors. Judges can be some of those positive role models. Judges must also be a part of the community and take leadership roles in bringing about collaboration among attorneys, residents, advocates, service providers, clergy, and nonprofits.”

Here is Townsend’s response to the same question

“Incarceration of minorities is in part the result of sentencing by Judges but also the result of laws and policies that will require changes by the Legislature. While I know that a Judge must apply the existing law to the facts of each case, to the extent I may have discretion in sentencing, and alternatives to incarceration are available, I would seek to avoid or limit incarceration when an alternative is appropriate. In addition, I believe judges who deal with these cases, and understand the problem, could help by drawing attention to the circumstances that call for legislative changes.”

Click here for Candidates’ Answers.  The election is April 4.  Click here for voting information.

NOTE:  Karofsky again supported establishment of a mental health law court in a WSJ article on March 26.   No mention of support from Townsend in the article.

Federal Funds Available for Mental Health Services that Help People Who are Homelesss

The Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) Center for Substance Abuse Treatment is accepting applications for FY2017 Grants for the Benefit of Homeless Individuals, which support the integration of behavioral health treatment and services for substance use disorders and co-occurring mental and substance use disorders, permanent housing, and other critical services for people who are experiencing homelessness.

SAMHSA funds will support three primary types of activities: (1) mental health and other recovery-oriented services; (2) coordination of housing and services that provide permanent housing and supportive services; and (3) efforts to help people with substance abuse disorders and co-occurring mental and substance use disorders access health care and other benefits.

Deadline for application is April 25.   Click here for more information.


Long Trip to Oshkosh Harms Those with Mental Illness and Costs the Taxpayers

An article in Cap Times by Abigail Becker describes the interaction between Madison’s police department and people with mental illness.  Click here to read “Crisis Cops.”

Becker describes the emotional and financial costs of the requirement that police take people in need of inpatient care to the Winnebago Mental Institute near Oshkosh.   People in severe mental crisis endure a 2-hour ride in a police car and police are unavailable for other duties.

Moses, an interfaith advocacy organization, has argued for the development of a local restoration center in which people in crisis could receive immediate help.   The idea has been effective in other communities.   Click here to read a case study of its implementation in Bexar County, Texas.

The League of Women Voters of Dane County will host a forum on April 5 from 7:00 to 8:30 at Capitol Lakes, 333 West Main Street on “Jailing the Mentally Ill:  Better Options.”   Click here for more information.

“You’ve Got to Have a Moral Compass Inside You”

There are lots of reports today that show the Republicans’ health care plan would help the rich and hurt the poor.  But, Sen. Joe Manchin,  (D-WVa) put it best.

“I got an older population, I got a poorer population, and I got an opiate issue we need to clean up,” Manchin said. “And now, talk about insult to injury. You’ve got to have a moral compass inside of you. You can’t do that. Look at the elderly, look at the poor, look at the sick. How can you look at yourself and say, ‘Okay, I’ll help the person who needs help the least, the wealthiest people, with more tax cuts, because I’m going to be taking away from the elderly population?”  (Reported in the Washington Post on 3/14)

For a more reasoned analysis, click on the NY Times article “Republican Obamacare Repeal Would Benefit Wealthiest.”

For an analysis of the effects in Wisconsin, read this report by Jon Peacock of the Wisconsin Council on Children and Families.  Click here.


Join “Listening Session” on Jail Diversion Options

NAMI-Dane County and MOSES are sponsoring a listening session to discuss issues related to mental health and the Dane County Jail.  Paul Saeman of MOSES will present successful models for jail diversion in other jurisdictions.  Carousel Bayrd, who attended the Stepping Up Summit in Washington, D.C., will offer the perspective of a member of the Dane County Board of Supervisors.

The event will take place at Trinity Lutheran Church, 1901 W. Winnebago St., Madison from 6:00 to 8:00 on March 16th.



Walker Requests Federal Grant To Address Opioid Epidemic, but Continues to Refuse Dollars from Medicaid Expansion

At the direction of Governor Walker, the Department of Health Services submitted an application to receive up to $15.7 million in federal funding over the next two years to curb opioid abuse and misuse.  The money is available under the 21st Century Cures Act, a massive bill recently passed by Congress with bipartisan support and signed by then-President Obama.

The funding will support community coalitions focused on reducing the non-medical use of opioids among teenagers and young adults, establish a hotline on treatment and recovery services and create opioid-specific treatment programs to reduce travel distance for those in need.  The grant would also create a network of individuals in long-term recovery from opioid abuse who are trained to help people through the process

The above report comes from the Wisconsin Health News.

WHN also reported on a recent presentation by Dr. Aleksandra Zgierska, a UW professor, and president of the Wisconsin chapter of the American Society of Addiction Medicine.  Her data show that deaths per thousand people from opioid addiction have more than doubled since 2003 in both Wisconsin and Dane County, with Dane County’s increase being greater until the last two years.

WHN quotes Madison Police Dept. Capt. Cory Nelson as saying, “For 28 years I’ve seen drugs come and go on the streets of Madison.  I have never in my life seen what’s going on with heroin currently.”

Click here for slides from the presentation.

It is certainly good news that Gov. Walker is willing to accept federal dollars to address this escalating crisis.  He has also called a special session of the state legislature to consider nearly a dozen bills addressing the problem.   What he has refused to do is accept federal dollars available through Medicaid expansion to increase treatment and prevention options for those who badly need them.

Click here to read “Americans with Mental Health and Substance Abuse Disorders: The Single Largest Beneficiaries of the Medicaid Expansion.”

UPDATE:  If Republicans have their way, mental health and substance abuse benefits will be stripped from the Medicaid expansion.  Even if governors were enlightened enough to accept the expansion, those benefits would no longer be available.  Click here to read the Post’s story about the loss of benefits for 1.3 million Americans in states where governors accepted Medicaid expansion funds.

UPDATE:  Click here for an account of the latest figures on deaths from the opioid epidemic and the success story of an woman who received treatment.

UPDATE:  Click here for a letter to the editor advocating for the ACA and parity requirement to address the opioid epidemic.

Federal Funds Available to Support Jail Diversion and Mental Health Efforts

Advocates in Dane County for jail diversion programs and increased mental health services repeatedly come up against the “we can’t afford it” response.  This post is part of a continuing attempt to highlight federal funding sources that are an answer to that argument.  But, initiative and effort are required to get the money.   Here is the most recent notice of a grant program that is addressed to needs identified by county legislators, non-profit organizations, and advocates.  Deadline for application is April 4.  Let’s hope someone gets busy.

The Justice and Mental Health Collaboration Program “seeks to increase public safety by facilitating collaboration among the criminal justice, mental health, and substance abuse treatment systems to increase access to mental health and other treatment services for individuals with mental illnesses or co-occurring mental health and substance abuse disorders.  (My bolding)

The program encourages early intervention for these multisystem- involved individuals; maximizes diversion opportunities for multisystem-involved individuals with mental illnesses or co-occurring mental and substance abuse disorders; promotes cross-training for justice and treatment professionals; and facilitates communication, collaboration, and the delivery of support services among justice professionals, treatment and related service providers, and governmental partners.

This solicitation specifically seeks to increase early identification and front-end diversion of people with mental health and co-occurring substance use disorders identified at early intercept points within the justice system.

This program seeks to increase the number of justice, mental health, and community partnerships; increase evidence-based practices and treatment responses to people with behavioral health disorders in the justice system; and increase the collection of health and justice data to accurately respond to the prevalence of justice-involved people with mental health and co-occurring substance use disorders.”

Click here for the grant announcement.