Denial Of Care

Denial of care
From the Houston Chronicle

If you are a mentally ill Houston adult without financial resources, getting arrested and locked up at the Harris County jail may be your quickest route to government-funded treatment.

Ever fewer hospital beds and services are available for such patients, and the closing of state institutions has forced thousands of them onto the streets, swelling the ranks of the homeless. For those in need, the jail has become the biggest single provider of mental health care in the area. Unfortunately, it comes with an arrest record.

And the situation is getting worse. A dwindling number of Texas psychiatrists provides compassionate help to mentally ill adults. Because of an archaic Medicaid regulation, those doctors are now being discouraged from dispensing it.

At the root of the problem is the original Medicaid legislation passed in 1965, at a time when many patients with serious mental illnesses were committed to state institutions, making short-term stays in private facilities an expensive, and little used, option. Those between the ages of 21 and 65 could not qualify for Medicaid coverage of mental health treatment delivered by physicians in private hospitals.

Since then the discovery and use of a new generation of pharmaceuticals has made hospitalization to establish a drug regimen for use in a home setting far more common. Unfortunately, the law has not kept up with the times and such care is beyond the reach of those without insurance. As a result of that restriction, Texas Health and Human Services Commission officials have sent demand letters to nearly 200 psychiatrists and institutions demanding return of Medicaid payments made in error. The totals range from $1,000 to $130,000.

The state is billing Texas physicians for the money because a federal audit found $1.67 million in improper payments made from 2001-2007.

Dr. George Santos, president of the Texas Society of Psychiatric Physicians, told the Chronicle's Todd Ackerman that the penalties will discourage mental health care professionals from treating indigent patients. Currently, there are only about 40 psychiatrists in Texas who do so.

“It is already difficult finding psychiatrists to treat patients in a hospital setting,” explained Dr. Santos. “Now, the few remaining are being punished for taking these patients.”

As Congress debates health care reform this year, lawmakers need to amend the outdated Medicaid regulations to reopen the doors of private hospitals and doctors' offices to a large segment of the mentally ill population who need better treatment options than simply going to jail.