Maryland Medicaid Cuts

If it didn't impact the lives of Marylanders most vulnerable, the recent request for comment by the Maryland Department of Health and Mental Hygiene (are we ever going to move two centuries forward and change that name) would be laughable.

The Mental Hygiene Administration, itself, has been the cause of hundreds of millions of dollars iof unecessary expenses to the state Medicaid budget. Some examples:

• A ten-year moratorium on the development of affordable housing opportunities by community mental health providers that has ultimately driven thousands of individuals to emergency room visits.
• An intense implementation focus on expensive, evidence-based practices that have not been proven to be efficacious in the state and cost the state tens of millions of Medicaid dollars.
• The reduction of psychiatric rehabilitation day program visits for people with severe psychiatric disabilities that has minimized their ability to learn social skills that help them integrate into the community.

These are just a few examples of how an administrative, void of strategic vision, has caused Medicaid expenditures to escalate over the last decade.

Unfortunately, the state provider association and the consumer "advocacy" organization, which is in the pocket of the Mental Hygiene Administration, have been largely ineffective in pushing for the changes that are needed to positively impact the State's Medicaid budget. If the State is truly interested in cutting costs in the Medicaid budget it needs a significant change in the vision, or lack there of, of the leadership of the Mental Hygiene Administration.

I just returned from an open house for a new affordable housing initiative in Baltimore City which is a shining example of the possibilities for creating housing for people with psychiatric disabilities. No one from the Maryland Mental Hygiene Administration attended the event. Why?

Because the administration has failed to understand that affordable housing is an integral part of the recovery process for people with psychiatric disabilities in Maryland. Instead, they have extended a moratorium on the development of affordable housing by mental health providers that has been in effect since 2001.

Despite the best efforts of small housing development providers like the one I attended today, the effects of the moratorium have been ruinous. This is not to mention the advocacy efforts of the state's consumer "advocacy" organization, in the pocket of the Mental Hygiene Administration, who has advocated for the moratorium, yet benefitted from state funding to develop their own housing.

Although it cannot be scientifically connected, emergency room utilization by people with psychiatric disabilities has increased over the decade.

The prohibition, initially based on financial, potential liability, has come back to bite the entire system. The state is looking to cut $40 million dollars in Medicaid savings would do well to look at the major reason for repetitive emergency room visits- housing.

MD budget hearings

I testified at the Senate budget hearing for the Alcohol and Drug Abuse Administration today and the committee was sympathetic and attentive.

What was really interesting, though, were the folks waiting to testify on the Mental Hygiene Budget. You had the lapdog provider association that has, for years, been "Chamberlainesque" in their dealings with the Mental Hygiene Administration for years, failing to protest obvious state violations of the Supreme Court Olmstead Decision and On-Our-Own members, who have forgotten the face of their fathers, don't come close to representing the vast majority of people with psychiatric disabilities and actually advocate for violations of the Olmstead Decision, specifically the moratorium on the development of affordable housing for people with psychiatric disabilities. This, at the same time, as they reap state monies to develop housing themselves. Hypocrites and violators of civil rights at the same time.

Ultimately, though, the problem lies with a lack of vision and leadership at the state level -- state leaders who pat providers on the head for not making waves or filing legitimate civil rights law suits or lining the pockets of "consumer" leaders who pretend to have the best interest of the masses with severe mental illnesses in mind.

In the richest state in the Union can we afford to have these perennial games go on? I would hope not.

But my hope is lagging.