Advocates for Medicaid expansion in Kansas are focusing on a new issue in their final push before next week’s election: They’re selling expansion as a way to address the state’s mental health crisis and the public safety concerns it’s giving rise to.
It’s no secret that the mental health system in Kansas is strained almost to the breaking point.
State hospitals are at capacity. And after suffering millions of dollars in budget cuts, community mental health centers are struggling to maintain services.
With fewer treatment options, more people with mental illness are running afoul of the criminal justice system, says Rick Cagan, the director of the Kansas chapter of the National Alliance on Mental Illness.
“If you don’t get treatment where you need to get it you’re going to end up somewhere else," Cagan says. "And oftentimes that’s homeless, that’s jail, that’s in the ER or possibly in prison.”
Nearly 40 percent of inmates in the Kansas prison system have some sort of mental illness. The same goes for about 20 percent of those serving time in county jails.
“We can’t have our jails become the mental health facilities or the new place to go if you don’t have insurance because we’re going to be paying for it. We are all going to be paying for this in the long run," says Usha Reddi, mayor of Manhattan and one of several local leaders urging state officials to address the problem.
Wichita Police Chief Gordon Ramsay is another. He says his officers are encountering more people on city streets who need mental health treatment – not arrest and jail.
“This is something whether it’s an administrative issue or a policy issue it needs to be addressed because it’s placing a substantial burden on our policing efforts," he says.
Hospital administrators are also sounding the alarm.
Bob Copple runs Via Christi in Manhattan. He says increasing numbers of people with mental illness are showing up in the emergency room--many because they have nowhere else to go.
“We recently had a patient here in our facility in Manhattan who had to have law enforcement with them 24-7 for over a week until there was a space they could go to for in-patient behavior health in our state," he says.
Copple, Ramsay and Reddi all spoke at events staged by Medicaid expansion advocates in recent weeks aimed at raising awareness before the election.
Cagan hopes voters are paying attention. Because, he says, expanding coverage to uninsured Kansans will trigger more federal funding for stressed hospitals and community mental health centers.
“Medicaid expansion would be the single biggest boon to the mental health system," Cagain says. "I mean, you know, 50 percent of individuals, adults and kids, with serious mental health conditions are not in treatment and certainly lack of insurance is one of the reasons why.”
Today, only the poorest families qualify for KanCare, the state’s privatized Medicaid program. Adults without children aren’t eligible no matter how poor they are.
Expanding KanCare would provide medical and mental health coverage to about 150,000 of those adults.
Gov. Sam Brownback and Republican legislative leaders have blocked debate on expansion over concerns that the federal government won’t meet its obligation to pay 90 percent of the cost. Also, Brownback objects to extending coverage to “able bodied” adults until Kansans with developmental disabilities – who are now on waiting lists – get the support services to which they’re entitled.
“We’ve got to meet these conditions because you have people who are not able bodied who do have dependents who are not getting the full set of services," he says.
Expansion supporters say while Brownback has raised objections, he’s never threatened a veto. And they believe that when the results of the legislative races are in, they’ll finally have the votes to force the issue by sending an expansion bill to his desk.