While our NAMI advocates speak for you, we need a giant chorus to make a difference!
Using the links below, call your Florida House Representatives and Senators and tell your story. What mental health services does your family need? Do you have a safe, affordable place to live? Thank you for adding your voice!
URGENT ACTION ALERTS!
Increase the Number of Mental Health Hospital Beds
How many of us have been in crisis only to be told by a hospital that they don’t have a mental health bed available, or that it will be 20 hours or more before one becomes available? One of the reasons for this is that there really are only a limited number of beds available for mental health care, because our local hospitals can not get reimbursed by Medicaid for more than 16 mental health beds. This stems from the days of deinstitutionalization when Institutions of Mental Disease (IMD) were being shut down; the intent at the time was good: to prevent the continuance of poorly-run ineffective large asylums. The care was supposed to be shifted to community mental health centers and local hospitals that offered psychiatric treatment, but the funding was never adequate.
We have an opportunity in Florida to change this situation and increase the number of mental health beds! Our Florida Medicaid Secretary can apply for an IMD waiver, now available from the federal government. This will allow Florida hospitals and other mental health residential treatment centers to be reimbursed by Medicaid for more than 16 beds. Please download the letter to encourage the Secretary to make this happen! Consider adding your personal story of being denied mental health hospitalization in our local hospitals.
Link to: NAMI Letter IMD FL Waiver
For more information link to: read the IMD Exclusion Fact Sheet
For the past 20 years, NAMI has fought for parity—the fundamental tenant that mental health care is just as important as physical health care. We have steadily made progress on this issue in both the hearts and minds of the country and its policies.
NAMI knows that the U.S. system of mental health care is failing to engage many people who seek help. The facts say it all: Many people who seek mental health care drop out. 70% that drop out do so after their first or second visit.
The first moments of interaction between a service provider and a person seeking care for a mental health condition can set the tone and course of treatment. This first interaction can start a journey to recovery and a satisfying life—or it can leave a person unsure or even hopeless about their future and unwilling to go back a second time.
NAMI recommends that insurance companies take the following steps to improve coverage under federal parity law:
- Maintain accurate, up-to-date directories of mental health professionals.
- Provide easy-to-understand information about mental health benefits.
- Promote integration of health and mental health care; expand these reimbursement models (an example is the Collaborative Care Model).
- Expand networks of mental health providers (recruit and contract with a wider range of providers, including MH and SA residential and inpatient facilities and allied MH workers such as peer and family support specialists).
- Cover out-of-network care to fill gaps in providers.
Additionally, they recommend:
- The State Office of Insurance Regulation (OIR) routinely conduct market audits of all commercial health insurers and Medicaid managed care for compliance with the Federal parity law. Specify measures they are taking to bring them into compliance with parity.
- Increase reimbursement rates and other incentives for psychiatrists and other mental health clinicians.
- Increase reimbursement and reduce barriers for tele-mental health services.
- Promote use of advance practice nurses and other health care professionals with appropriate training to prescribe mental health meds.
Examples of Non-Parity:
- Requiring prior permissions to get MH treatment
- Paying psychiatrists and psychologists less per hour than family and other doctors
- Requiring a med other than what the doctor prescribes because it is less expensive
- Not enough MH practitioners in-network
- Limiting the number of inpatient treatment days when that limitation is not applied to medical benefits
Florida’s OIR (Office of Insurance Regulation) needs the full support of the Florida legislature to evaluate and enforce the Federal Parity Law under the MHPAEA (Mental Health Parity and Addiction Equity Act). Employers who sponsor self-funded health plans that cover Mental Health and Substance Use Disorders should know that any difference between the handling of MH/SUD benefits and comparable medical/surgical benefits is probably illegal.
If parity is enforced:
- Insurance companies will pass the increases in their costs on to the larger pool of consumers, just as they do for other chronic illnesses, such as diabetes or cancer.
- It will save taxpayers money because they are already paying even higher costs for avoidable ER visits and hospitalization and incarceration than if Mental illness were adequately covered in the first place.
- The parity law has an “escape hatch” for insurance companies, providing relief to any insurer that, after the first year of full compliance, if the cost of coverage increases more than 2% and, after the second year of coverage, increases more than 1%, the company may seek an exemption from the law.
- For those receiving coverage through Florida Medicaid (800,000 people), it will mean that they get the care they need, early, so that they can lead lives of recovery with brighter outcomes.
In Florida, the existing law permitting discrimination against MH/SU disorder patients must be repealed, from HB939: 409.967, F.S.; requiring Medicaid managed care plans to submit an annual report to the Agency for Health Care Administration (AHCA) relating to parity between mental health and substance use disorder benefits and medical and surgical benefits; specifying required information in the report; amending s. 627.6675, F.S.; conforming a provision to changes made by the act; transferring, renumbering, and amending s. 627.668, F.S. (commercial health insurance companies).
Since most mental health care is provided through Medicaid and at more reasonable rates, we should expand Medicaid in Florida to include the “working poor” who currently make too much to qualify for Medicaid but also can not afford their own health insurance.
Medicaid Expansion: Facts and Figures
What is Expansion?
- Medicaid expansion under the Affordable Care Act (ACA) includes adults under the age of 65 with incomes up to 138 percent of the Federal Poverty Level (FPL). For 2017, this is $16,643 for an individual and $33,948 for a family of four.
- A June 2012 U.S. Supreme Court ruling made expansion of Medicaid optional for states.
- For Medicaid expansion states, the federal government covered 100 percent of the Medicaid costs for newly eligible enrollees in 2016 and will cover 94 percent of costs in FY 2018. The federal share phases down to 90 percent in 2020 and thereafter.
- Medicaid expansion is long overdue in Florida! Over 700,000 Floridians would gain health coverage if our state adopted this common-sense option.
- We’re encouraged by the momentum for Medicaid expansion via ballot initiatives around the country in places like Maine, Idaho, Utah, and Nebraska.
- The federal government would return Florida’s tax dollars to pay for 90% of the costs. This will have a significant impact on the state’s economy.
- Closing the health care gap could save the state budget millions. The Florida Policy Institute estimates that Florida would have saved $501,950,000 in 2018 alone.
- Closing the coverage gap would reduce the immense burden on hospitals and clinics that provide free and reduced cost care to low-income, uninsured, and vulnerable populations, such as those with serious mental illness.
- Since most mental health services are delivered via Medicaid, more people would get the care they need.
- To qualify for Medicaid in Florida, a family of four with dependent children must not earn more than 30 percent of the FPL, or $7,380 per year.
- To qualify for marketplace health insurance assistance, a family of four with dependent children must earn at least $24,600 per year. Families earning between $7,380 and $24,600 annual income are not eligible for any coverage, representing the coverage gap.
- Adults without dependent children are currently ineligible for Medicaid unless they have severe, long-term disabilities.
- Medicaid expansion would benefit hard-working Floridians. 63% of potentially eligible parents work outside the home (mostly service/tourism jobs), and 24% are not in the labor force (ex: students, homemakers, retirees).
- Closing the coverage gap will decrease health disparities between communities of color and other communities by providing more access to preventive screenings, prenatal care, wellness checkups, mental health care, and routine visits with physicians.
- Medicaid expansion would give tens of thousands of Florida’s veterans access to comprehensive medical care.
- Medicaid expansion in Florida would help reduce the health disparities found in rural areas, where higher rates of nearly every disease and condition exist.
Contact your Florida state Representative and Senator to ask them expand Medicaid in our state: