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Medicaid

A woman signs a petition April 12 to have the Medicaid expansion gap initiative placed on the ballot.

BOISE — Jessica Rachels watched the room from a corner booth at Beside Bardenay. It was an election night party, and the place was full of people who had campaigned to get Medicaid expansion on the ballot — for adults like her.

The crowd cheered as the poll results got posted. By the end of the evening, Medicaid expansion was solidly on its way to becoming law, with more than 60 percent of the vote.

“I haven’t had insurance except when I was pregnant,” Rachels said. That was years ago.

It was June when Rachels received a diagnosis of bipolar disorder — an illness she’s pretty sure she’s had for years. She has paid out of pocket for treatment since then. Therapy, a psychiatrist appointment, medication and blood work have cost hundreds of dollars.

Medicaid expansion will open insurance coverage to Rachels and thousands of Idaho adults like her.

Thousands to get mental health care

James Baugh, executive director of Disability Rights Idaho, says that 20,000 to 25,000 is a “very conservative” estimate of adults with mental illness who will gain health care under expansion. That counts only severe, chronic illness such as bipolar disorder. (The 50,000 to 60,000 Idahoans in the Medicaid gap likely also includes a lot of people who, say, had a bout of depression last year, he noted.)

“There are very inadequate sources of treatment for those people,” said Baugh, a prominent advocate of Idahoans with mental illness.

Many uninsured Idahoans do get mental health care now, he said, but that treatment often comes only from a crisis: an arrest or a psychotic break that leads to hospitalization.

Mental health care for people in the latter category now is often paid by the state and counties. Mental health claims for Idaho’s poor who are uninsured cost more than $8.5 million statewide in fiscal year 2018, according to data from the state’s Catastrophic Health Care Program. Ada County spent $3.9 million and Canyon County spent $2.3 million. And those costs were rising. For both counties, it was a more than 30 percent increase from the prior year.

Medicaid can pay for preventive care, prescription medication and therapy, and it will pay those previously uninsured bills.

What may stand in the way

Of course, the vote to expand Medicaid doesn’t guarantee that all people will immediately get their mental health needs met. The Republican-dominated Legislature, which has refused for years to expand Medicaid under the Affordable Care Act, might change the law to add a work requirement, which can keep people with mental illness out of the program.

“People (with serious mental illness) are really put at a disadvantage, and they tend to drop out of the process,” Richard G. Frank, a health economics professor at Harvard Medical School, told The Commonwealth Fund.

“We know that giving people access to treatment increases the chance they will get better and be able to work,” Frank said. “But if you impose barriers to getting treatment — like kicking people off the Medicaid rolls — you’re actually reducing the chance someone will be able to work.”

And even though people with mental illness could gain insurance, that doesn’t necessarily mean they’ll gain treatment. Idaho has a statewide shortage of mental health providers — especially psychiatrists and psychologists. A famously low-paying health insurance plan can’t fix that, according to advocates.

They argue, however, that it does give Medicaid providers some financial benefit to taking patients who previously couldn’t pay at all.

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