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With pressure from the APA Practice Organization (APAPO) and other health-care advocacy groups to not cut Medicaid benefits, Congress approved in April a federal budget blueprint for fiscal year 2006 with a whittled-down $10 billion in Medicaid cuts over the next five years. The administration had originally proposed $45 billion in cuts over 10 years. The reduced Medicaid program outlays are not slated to take effect until 2007. This is an important change for mental health professionals, say APAPO representatives, as Medicaid is the nation's largest source of funding for mental health services like substance abuse rehabilitation and treatment of mental disorders.

Congress also agreed to create a new commission, the Medicaid Commission, which will inform further Medicaid budget decisions with the input of health-care experts. APAPO, through state and federal advocacy efforts this spring, argued for the commission by asking that expert opinions be considered in budget decisions. The commission, set up by the Department of Health and Human Services, will consider the potential effects of cuts and ways to increase efficiency, and will make recommendations based on their findings.

As the commission is set up and begins its work this fall, APAPO will continue its targeted grassroots advocacy by psychologists, coalition work and education of commission members about the value of psychological services, says APA Executive Director for Professional Practice Russ Newman, PhD, JD.

"We must help the commission understand that it is shortsighted to cut back beneficiaries' mental health services," Newman says. "We have 30 years of research that demonstrates that providing adequate mental health services when they are needed actually saves monies in the long run."

Newman adds that, beyond educating commission members, APAPO will also work to influence the Senate Finance and House Commerce committees as they vote on a bill this September to produce the $10 billion in Medicaid savings.

Minimizing cuts

This year's APAPO advocacy efforts began in January as the new Congress geared up for the budget resolution process, Newman says. In March, the House of Representatives approved a 2006 budget that called for up to $20 billion in Medicaid cuts. The next day, the Senate removed from its 2006 resolution an instruction to cut Medicaid growth by $14 billion, thus favoring the commission rather than any cuts. The differing House and Senate resolutions led to a conference process that split the difference, with $10 billion in cuts plus the commission.

The sizable drop in Medicaid cuts shows APAPO's sustained advocacy through the first half of 2005 has paid off, says Marilyn Richmond, APAPO assistant executive director of government relations.

"It's hard to have any cuts at all, especially to this critical program that provides a safety net for delivering mental health services to individuals in need," Richmond says. "But, at the same time, the proposed cuts started out so high, it is a success to see them drop."

Working with state psychological associations and other organizations nationwide to prevent Medicaid cuts, APAPO:

  • Co-signed a letter to President Bush in January calling for no cuts or caps on Medicaid and another letter to members of the House and Senate's conference committee.

  • Supported the effort by Sen. Gordon Smith (R-Ore.) to establish the Medicaid commission.

  • Reached out to conference committee members and urged conferees and House Republicans to reject proposed Medicaid cuts and create a bipartisan Medicaid commission.

  • Worked to strengthen a coalition of 130 advocacy organizations chaired by the group Families USA.

  • Provided grassroots support for a "Dear colleague" letter sent by Rep. Heather Wilson (R-N.M.) that supported the creation of the Medicaid commission.

  • Mobilized grassroots networks of psychologists and other health-care professionals to contact their senators and representatives to show their opposition to Medicaid cuts and support of the Medicaid commission.

Key mental health funding

The congressional work to minimize Medicaid cuts came shortly after the release of a report from the Substance Abuse and Mental Health Services Administration (SAMHSA) that says public resources, like Medicaid, paid for 63 percent of mental health spending in 2001, up from 57 percent in 1991. That includes spending on psychiatric hospitals, prescription drugs, substance abuse rehabilitation and outpatient mental health treatment for children.

Furthermore, the report, guided by SAMHSA psychologist Jeffrey Buck, PhD, shows public resources paid for 76 percent of substance abuse treatment in 2001, up from 62 percent in 1991.

The study, National Expenditures for Mental Health Services and Substance Abuse Treatment 1991-2001, reports that public spending for mental health services and substance abuse treatment amounted to $67.4 billion in 2001, while private spending amounted to only $36.3 billion.

Further Reading

To see the full SAMHSA report, go to www.samhsa.gov/spendingestimates/toc.aspx.