When the 2013 legislative session wraps up, a big policy question will remain: Will the state make Medicaid available to a greater number of Idaho’s poor? The federal health care law encourages that move. It’s a debate that involves potential costs and savings, along with patient well-being. And it turns quickly to chronic conditions, like mental illness.
Mitchell Ponting is 48 years old with neatly trimmed gray hair and a quick smile. When he was paroled from prison last summer after serving two years on drug charges, he faced an immediate problem.
Ponting has degenerative disk disease and arthritis, and takes prescription narcotics for the pain. Two other prescriptions help him manage otherwise debilitating depression. “Without my mental health meds, I’m a wreck,” he tells me.
He becomes reclusive, he says, and unable to hold normal conversations. But medication gives him a different relationship with his disease.
“It’s always there, but I have the ability to – I don’t want to say sidestep it,” he says, thinking aloud. “I have the ability to keep it down.”
Not long after he was released from prison, Ponting found his way to a small adult behavioral health clinic in Boise run by Easter Seals-Goodwill. They provide low-cost mental health and substance abuse treatment, and they specialize in serving people on felony probation and parole. DeLanie Valentine directs the clinic
“We have so many people that come in with chronic illnesses,” she says. “They have never been to a doctor.”
Valentine says the people she sees may have gotten good health care in prison. But then, like Ponting, many are let go with a couple of weeks-worth of medication, and prescriptions they don’t have the means to fill. Because of that, she says, the clinic sees a lot of desperation.
“Our clinical supervisor has an hour a day blocked out for crisis intervention, because we do have people coming in in crisis that often,” Valentine says.
“Crisis” can mean a lot of things. If someone is suicidal or imminently dangerous, the clinic calls the police. In medical emergencies, the ER. If it’s a mental health crisis, the ER is often the only option.
“Right now, if we can’t serve them, the only place we can tell them to go is the emergency room,” she explains. “And that’s not the right answer. It’s so much more expensive.”
In Idaho, a single adult makes too much money to qualify for Medicaid if he earns more than $205 a month. Bills for expensive emergency care can wind up going to counties and the state. Another county expense that’s rising quickly is the cost of keeping people with mental health problems in custody until they’re seen by a judge. John Traylor is Director of Indigent Services for Ada County.
“My entire budget is $11 million, and last year $2.2 million of that went to involuntary mental health,” he says.
That $2.2 million is nearly four times what his office spent in 2008 to keep people in protective custody for mental health reasons.
“Is it a large amount of money?” Traylor asks. “Yes it is. And is it continuing to grow every year? Yes it is.”
Indigent services offices like the one Traylor heads are at the center of why counties and the state could save money if lawmakers allow more Idahoans to receive Medicaid. Under Idaho code, counties cover a portion of the hospital bills of people poor enough to warrant help. A state pool called the catastrophic health care fund picks up the rest. Roger Christensen is the CAT fund’s board chairman – and he admits it has problems.
“It’s expensive to the taxpayers in Idaho,” Christensen says. “It’s paid for by the property taxes in the counties and also the state general funds. And I think the total cost this year is approaching $60 million.”
If lawmakers expand Medicaid eligibility, the federal government will pick up many of the bills now paid by counties and the state. But that’s not the only reason Christensen favors expanding Idahoan’s access to the federal program. He believes it will offer more efficient and humane care than the CAT and county indigent funds. The current system doesn’t pay for regular, preventive care.
“We just pay for it after it gets to the critical point and goes into the hospital, and then we have a large enough hospital bill to qualify,” he says. “Whereas Medicaid is membership-based, and they can go in and get the services ahead of time, which does cover preventative care.”
Christensen says the predicaments of people with mental health problems make a clear case for expanding Medicaid eligibility. Untreated, mental illness can spiral. That, Christensen says, is a costly and unnecessary cycle. All of which takes us back to Mitch Ponting, and the Easter Seals-Goodwill clinic.
“I was raised around bikers, and part of the life was drugs,” Ponting says. “I was 13 when I did my first shot of methamphetamine.”
Ponting thinks he knows what might have happened to him, had he not found help. He might have gone back to drugs. Instead, he was able to stay on his prescribed medication. Now he has federal disability benefits, which give him Medicaid access. He believes he can follow an upward path.
“We all have choices, and I choose to be the person I am today,” he says. “And I choose to be a better person tomorrow.”
The governor and lawmakers have a choice before them, too. By expanding Medicaid eligibility, they’ll give 100,000 more Idahoans access to a federal entitlement program many regard as bloated. If they don’t expand access, they’re left with rising state and local spending on costly emergency care.