Mr. SMITH CASE

Mr. Smith Case

Mr. Smith Case

Introduction

Medicaid is the dominant payer for state mental health services. Medicaid now funds more than half of all mental health services administered by states and could account for two-thirds of such spending by 2017. Ten percent of all Medicaid dollars were spent on mental health services in 2003. The trend toward greater Medicaid funding of mental health services began soon after the Medicaid program was enacted in 1965, as mental health care shifted from institutional settings, where Medicaid funding is limited, to community settings, where it is more readily available, and as Medicaid began taking over more of the financing role previously held by state or county mental health authorities (5,6). More recently, Medicaid funding of mental health services has also grown because of efforts by states to obtain federal Medicaid funding for services previously funded entirely with state or local dollars.

Increased Medicaid funding of mental health services has substantially changed the state mental health policy landscape. Federal Medicaid requirements have reduced the flexibility states previously had to shape mental health services and their delivery, and pressures to use state mental health dollars to obtain additional Medicaid funding have sometimes limited the ability of mental health agencies to provide services for those not eligible for Medicaid

Eligible individuals do not have to be retired to get Medicare. Unlike Social Security, working people can still receive full Medicare benefits at age 65. People who are already receiving Social Security benefits are automatically enrolled in Medicare without an additional application.

Discussion and Analysis

Although federal law requires that the Medicaid agency retain ultimate authority over all aspects of the Medicaid program, states may delegate responsibility to mental health agencies and other entities for a variety of Medicaid administrative activities. Consequently, administrative arrangements vary considerably across states. State and county mental health agencies generally have more experience than Medicaid agencies in designing and administering programs for the population with mental illness, so it is important to understand how Medicaid agencies work with mental health agencies to utilize their expertise and what organizational and funding factors facilitate or impede such collaboration.

Whereas most people do not pay a premium for Medicare Part A, they are responsible for a deductible for inpatient hospital stays. The deductible is the amount a person with Medicare must pay for healthcare before Medicare begins to pay. There was a deductible of $1,024 in 2008 for hospital stays ...