December 15, 2009
Open Letter to Legislators:
We are writing to voice our concern and opposition to any action to repeal protection of open access to psychiatric medications under Medicaid. Such protection has existed since 2004 in Michigan in the forms of Public Acts 248 and 250 of ’04.
With Michigan feeling the impact of the economic recession, the executive branch requested, and the Legislature acquiesced in the FY-10 DCH budget, a General Fund savings assumption of $5 million through bureaucratic prior authorization of psychiatric medications. Regardless of the savings assumed (and $5 million is an extremely small amount within the total state budget context), this cannot be implemented as long as Public Acts 248 and 250 of 2004 remain in place. We are respectfully asking all legislators to assure that these laws, which the Legislature saw great need for just five short years ago, are neither repealed nor modified.
If mental health drug prior authorization is reinstated, then Community Mental Health programs and other publicly reimbursed providers, all with significantly reduced budgets, will have to take on additional clinical and administrative burdens as they did prior to 2004. From time on the phone with Michigan Medicaid’s private, for-profit contractor in Virginia; to a policy that dangerously requires persons with severe mental disorders to fail twice on medications that the state “prefers”; to an appeals process that does not work and few doctors even know about, our mental health system will become counter-productive and more expensive.
In a world without open access to drugs for those diagnosed as having mental illness, there would be more emergency care needed. A study of mental health drug prior authorization in Maine revealed that enrollees in prior authorization programs were 1.3 times more likely to experience discontinuity in treatment, and two-thirds of this discontinuity was related to medication. Besides the harm to enrollees, discontinuity in medication is strongly associated with increased hospitalization and will cost the state more in such care. According to the California Office of Statewide Health Planning and Development, the average bill for a psychiatric hospital in 2002 was $2,222 per day, whereas even the most expensive medication costs far less.
A priority to our state right now is job creation. However, this priority cannot be met by cutting open access to mental health medications. Without that access, a large number of those with mental illness may become unemployed because they will be unable to obtain the medication necessary to function productively. Instead of creating jobs, more people will rely on state social services, including even incarceration, as our justice facilities are already overburdened with persons experiencing serious mental disorders. A 2008 study conducted by the National Alliance for Mental Illness–Ohio found that, through trying to save money (a projected $6 million) by denying access to mental health medication, the Legislature would actually cost taxpayers over $23 million in social services and other state agency costs.
Another priority for the state is family preservation. Yet restricted access to psychotropic medications tears families apart by pushing more people with serious mental illness into homelessness. Untreated or inadequately treated mental illness is known to be a significant contributing factor to at least one-third of homelessness cases.
Appropriate medication is essential to quality of life. One individual served by the public mental health system was forced to change his medication simply to save money. This action followed a long period of stability (over fourteen years) without hospitalization and a long work history. Following the medication change, this individual was hospitalized. As a result he experienced increased symptoms and lost many work days. Similarly, a young adult, currently an honors student at a Michigan university, was unable to attend school until she was on appropriate and consistent medication. And, prior to Public Acts 248 and 250 of 2004, an eight-week “hotline” run by the Mental Health Association found that two-thirds of 360 consumer and family callers had experienced negative consequences from medication prior authorization. These are all examples of how this state and its citizens will be affected by a repeal of open access to mental health medications.
An alleged savings of $5 million GF (the amount could even be smaller) is clearly not worth the pain, suffering and societal consequences that would ensue. That’s a “bargain” our state doesn’t need. Please join us (the members of the state’s federally required mental illness planning and advisory body) in denouncing any efforts to repeal this important protection.
Sincerely,
The Members of the State’s Advisory Council on Mental Illness (ACMI)*
*Please note that members of the ACMI who work for State Government abstained from
taking a position on this policy issue
