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Guest column by Sue Abderholden

As Congress moves towards making changes to the Medicaid program, it’s important to understand the impact on people with mental illnesses. Why? Because Medicaid (called Medical Assistance in Minnesota) is the largest payer of mental health treatment and services.

The first change is requiring adults without children who are not certified as “disabled” (the Medicaid expansion group) to work or volunteer 80 hours a month. On the surface, many people think this is a good idea. The problem comes in determining who is “disabled.” Many people, especially young adults, who are experiencing a mental illness are not certified as “disabled.” It is an onerous process. It takes an average of eight months for the Social Security Administration (SSA) to process an application for disability, and 70% of all first-time applications are denied. Because there is no blood test or MRI that can prove you have a mental illness, applications from people with a mental illness are routinely denied. People then appeal or submit new applications, and it can literally take three to four years for someone with a mental illness to qualify.

So, what happens during that time? How can people access the medications and treatment they need so they can work? It also takes insurance to access the professionals to fill out the paperwork. And honestly, do we want to tell young people to tell the SSA that they won’t be able to do any substantial work in the future?

The second change is requiring this same group of people to re-enroll every six months. The paperwork to do this is arduous. The form is 31 pages long, 15 of which must be filled in. With the re-enrollment process after COVID-19, we saw that people had difficulty filling out the paperwork, and many counties had difficulty processing the applications.

The third change is requiring copayments. Some believe that copayments lead people to use their health insurance benefits more carefully and effectively. However, many studies show that copayments become a barrier to care if you are low-income.

The savings attributed to these changes are due to people losing their health insurance and their Medicaid — or reduced health care utilization (and worse health outcomes).

People with mental illnesses depend on Medicaid to access their medications, therapy, in-home supports, and so much more. Let’s be sure to understand that these changes will negatively impact our mental health system and lead to more uncompensated care, which will add more pressure to an already fragile system.

Sue Abderholden is executive director of NAMI Minnesota.