Medicaid Cuts Could Have Dire Impact on the Disabled

Kim Krisberg

Nations Health. 2005;35(5) 

In This Article

People With Mental Illness Endangered

Medicaid has also become the primary public payer for mental health services, and people with mental illness who depend on the program would have nowhere else to turn if cut from the rolls, according to the National Mental Health Association. Among Medicaid's accomplishments is greatly improving access to community-based care as an alternative to in-patient care, which the association believes is a better avenue for treating mental illness, said Kirsten Beronio, senior director of government affairs at the National Mental Health Association.

"We don't really know what exactly (policy-makers) will cut from Medicaid...but what we do know is that over half of state and locally administered mental health funding comes through the Medicaid program," Beronio told The Nation's Health.

Increasing Medicaid co-pays for prescription drugs -- an increasingly important part of mental health treatment -- is another area of concern for Beronio and her colleagues. Prescription drug coverage is an optional Medicaid benefit, but because of their significant impact on managing physical and mental disability, all Medicaid programs cover drug access. Cutting prescription drug access for people with mental illness could be catastrophic, Beronio said.

"Often what will happen is these folks will go into psychiatric crisis and end up in (emergency rooms), which we're already seeing happen as a result of cutbacks in states," she said. "We could also see more people with mental illnesses ending up in jail."

According to Gwen Gillenwater, director of advocacy and public policy at the National Council on Independent Living, most of the Medicaid programs serving people with disabilities are created under optional waivers, which allow states to tinker with how Medicaid is administered and still receive federal funds. But with state budget crunches, waiver programs often become a first target, she said.

"People with disabilities have a great deal more health issues and often, especially in the mental health area, are on medications," Gillenwater told The Nation's Health. "So, what are their options going to be (if they lose Medicaid coverage)? Ninety-nine percent of the time, they won't be eligible for health insurance, so they'll be left high and dry. I don't have any figures in front of me that say people are going to die, but they will."

A misconception, Gillenwater said, is that anybody with disabilities on Social Security Disability Insurance also qualifies for health care via Medicare, the nation's health care program for older Americans. However, after someone is determined eligible for Social Security Disability Insurance, there's a two-year waiting period before they can get on the Medicare rolls. During that waiting period, Medicaid is usually the only option, Gillenwater said. Another worry is cutbacks to Medicaid buy-in options, which are determined state by state, she noted. Allowing the disabled to buy into Medicaid via premiums actually serves as an incentive for them to stay in the work force and pursue different career opportunities.

"I wish that rather than focusing so much on Medicaid, we'd focus on health care and ways to better control costs, (savings of which) would ultimately come down to Medicaid," Gillenwater said. "If the focus was on health care...then we could find some solutions that might have a positive impact. But I'm not sure what (cutting Medicaid) is going to solve."

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