I have been following with great interest the public debate in this session of the General Assembly and throughout Virginia regarding the choice to expand eligibility for Medicaid or to pursue some other approach to expanding access to health care for uninsured Virginians through the Health Benefit Exchange.
Related to this debate is the recent proposal in the General Assembly to conduct a two year study/audit of the Virginia Medicaid program and to delay expansion of eligibility for Medicaid. I disagree that the Virginia Medicaid program is in need of yet another financial and programmatic audit. And, I would like for the readers of the Daily Press to consider an aspect of Medicaid expansion that I have not yet seen discussed.
This issue is the important role that Medicaid plays in providing reasonable access to non-crisis treatment for individuals with mental illness. It might be a surprise for most Virginians to learn that Medicaid funds the majority of community-based behavioral health services (non-State Mental Health Facility) throughout the Commonwealth. There are exceptions where the numbers of residents eligible for the current Medicaid program are relatively low, but among the 135 localities served by the forty Community Services Boards and by hundreds of private behavioral health companies, Medicaid is the primary funding source for individuals who have mental illness and who need access to community-based care.
We have all been reminded of the critical safety net role of the 40 Community Services Boards (CSBs) in responding to the crisis end of the behavioral health continuum with the Emergency Custody Order (ECO) and the Temporary Detention Order (TDO). The role of Medicaid in funding non-crisis treatment is the missing ingredient in this very public and often passionate discussion about how to improve the state's response to accessible behavioral health services such as outpatient therapy, psychiatry, medication management, skill building services for adults with mental illness, in-home services, partial hospitalization and case management.
Let me provide an example from the local CSB. Revenue for the HNNCSB for the last fiscal year was as follows: earned fee revenue, primarily Medicaid, 55 percent of the total; local tax revenue was 5 percent, Federal Block Grant Funds were 5 percent and State funds provided 17 percent of the total; 18 percet was from other sources. The point is that earned revenue, primarily from Medicaid rather than local, state or federal revenue, sustains this and most other Community Services Boards. This reliance on Medicaid is the direct result of public policy created and maintained during each Session of the General Assembly beginning in 1992. To put this reliance on Medicaid in a different perspective, over the past five years (FY 09, 10, 11, 12, 13) this CSB has brought into the cities of Newport News and Hampton $177,209,629 of earned revenue and of this total over the five years, $127,801,423 was strictly Medicaid revenue.
There are at least two take-aways from this: the "safety net" community behavioral health system/CSB on the Peninsula (HNNCSB) would not exist except for Medicaid and this source of funding as required by the General Assembly has reduced the burden on local taxpayers to support this essential array of high quality and accessible community based behavioral health services. Last fiscal year we served 12,296 individuals. Of this number, 5,287 did not have private insurance or eligibility for Medicaid. Close to 43 percent of the clients in this essential safety net system of care have no insurance and currently are not eligibile for Medicaid. These figures do not include the almost 180 individuals in the Hampton Roads Regional JaIl who are on medication for mental illness and who originated from the Peninsula.
Secondly, if access to behavioral healthcare prior to a crisis is a core value of this Commonwealth, then the very first solution for our desperately broken system is to quickly expand eligibility for Medicaid. This one step would immediately allow state-wide access to care especially for young adults who are are over-represented in our uninsured populations.
Finally, this CSB, as one of the largest of the Medicaid behavioral health providers in the Commonwealth, has been audited routinely, sometimes on a monthly basis, sometimes by two different auditing agencies at the very same time. The State Medicaid office (DMAS) does not need to have yet another comprehensive audit as many have been performed in the recent past and, audits of and by DMAS are almost crushing service delivery as it is.
Hall is executive director of the Hampton-Newport News Community Service Board (CSB)
