Group urges state to expand Medicaid for young adults with mental illnesses

Advocates in Jefferson City are lobbying for expanded access to Missouri Medicaid for young adults suffering with mental illness.

Members of the National Alliance on Mental Illness are working to establish a waiver that would allow people age 21 to 25 to obtain health care through Medicaid at the first signs of serious mental illness.

Cindi Keele, executive director of NAMI Missouri, said the project was inspired by recent studies showing how effective treatment can be if it begins soon after a patient’s first psychotic episode.

The waiver campaign is supported in part by the Recovery After an Initial Schizophrenia Episode program — RAISE — that was created by the National Institute of Mental Health to facilitate early treatment.

Several disorders can induce psychosis — not just schizophrenia. Certain types of bipolar disorder or depression also raise the risk of psychotic episodes.

“There’s a spectrum of disorders,” Keele said. “No two brains are alike. There’s a lot of mixing of symptoms.”

Typically, the first serious manifestations of mental illness show during late adolescence and early adulthood.

This coincides with a life stage wherein many people are working low-wage or entry-level jobs and are less likely to have access to adequate health care.

Keele said often, an person’s first psychotic episode will land him or her in the emergency room.

Once stabilized, the person’s chances of receiving effective care are poor.

People may be given improper medication or insufficient supervision and encouragement to continue taking medication or be given no medication at all.

According to NIMH figures, people go an average of eight to 10 years between their first psychotic episode and effective intervention.

By that time, the costs of care often have increased dramatically as the illness progresses toward the point of disability.

“It’s pretty dramatic and [runs] counter to recovery,” Keele said, adding during that interim period, people can lose contact with friends and family.

Homelessness, incarceration and suicide are not uncommon.

“It’s just assumed that they’re going to go into the trajectory toward disability. ... But now we have research that says that doesn’t have to happen,” she said. “It’s going to save us a fortune, but it’s going to cost upfront.”

Aggressive diagnosis and intervention at the first sign of trouble have been shown to reverse that trajectory.

“This could fundamentally change the way we go about delivering mental-health services in the community,” Keele said. “[Mental-illness sufferers] may not be cured per se, but they could learn to manage the illness and return to school and work. They could have a normal life; get back to the American dream.”

But access to Medicaid is crucial, she said.

Sue Floyd, who runs the Depression-Bipolar Support Alliance of Southeast Missouri in Cape Girardeau, said she supports expanding access to Medicaid because people with mental illness often have few other options.

“[The waiver campaign] is tremendous,” she said. “Many people with mental illness are waiting for Medicare disability. That’s the only way they can get their medication.”

She said mental illness affects the poor more seriously than the wealthy because the disparity in access to and quality of care.

She said she’s noticed area professionals go to St. Louis for better treatment, while low-income people sometimes go without.

But even so, Missouri’s current Medicaid regulations are strict for the young adults.

“One of the stingiest [Medicaid programs] in the nation,” Keele said of Missouri’s program.

For example, a single mother with two children making $5,000 annually is considered too wealthy to qualify under the current system.

Unless a person already has been declared disabled, Keele said, it’s extremely unlikely for him or her to become eligible for Medicaid.

The Affordable Care Act has increased access to health care, but mental-health advocates say more is needed.

NAMI is organizing a rally at the Missouri Capitol on Wednesday.

DBSA member Linda Sanders said she plans to attend.

“I got in touch with them whenever I heard about that,” she said. “That’s important.”

The theme, “B4Stage4,” urges lawmakers to recognize the benefits of early diagnosis and treatment.

NAMI also is organizing a public hearing to discuss the waiver effort from 9 to 11 a.m. March 11 at Community Counseling Services in Cape Girardeau. All are invited to attend.

tgraef@semissourian.com

(573) 388-3627