Rockville Woman Criticizes Medicaid Rule Changes

By MICHAEL WALSH, Capital News Service

WASHINGTON - The mentally ill would be forced back into "warehouse conditions," under proposed changes to Medicaid, Rockville resident Barbara Miller told the House Committee on Oversight and Government Reform Thursday.

Miller testified on behalf of the National Council for Community Behavioral Healthcare against changes to six Medicaid regulations, including narrowing the scope of Medicaid outpatient hospital services that she used while being treated for a mental disorder.

The changes were proposed by the Centers for Medicare and Medicaid Services, a federal agency.

"If the federal government withdraws financing for (outpatient services), many more persons with serious mental disorders will end up in emergency rooms, inpatient hospitals, nursing homes or the prison system," Miller said.

The states would take the brunt of the rule changes, said committee Chairman Henry Waxman, D-Calif.

"If implemented they would cause major disruption to state Medicaid programs and the people and institutions that depend on them," he said.

Miller was dependent on the programs when she was diagnosed with bipolar mood disorder in the early 1970s. She was moved to a state-run mental hospital like most mentally ill patients in the 60s and 70s, she said.

"It was a terrible experience," Miller said of her stay at Springfield State Hospital in Sykesville, Md. "The doctors there struggled to give me a proper diagnosis and I've got to tell you the truth, it was like living in a warehouse."

With the rehabilitation help of Threshold Services in Montgomery County, she was able to reassimilate, Miller said.

Miller now works at the Hearing Loss Association of America and serves as a deaconess and assistant director for the youth department at her church.

"In addition to medication and therapy it's worth noting that these rehabilitation services permit people like me to live in the community and make a contribution," Miller said.

Other CMS proposals include prohibiting federal matching funds for graduate medical education programs, non-medical rehabilitation services and school transportation and administrative activities.

In addition, the changes would reduce health-care-related revenue taxes and limit payments to public providers to cover costs of treating Medicaid patients.

Waxman called the changes "a thinly disguised assault on the health care safety net" and hoped that CMS would, "go back to the drawing board."

Dennis Smith, testifying for CMS, said the rule changes were necessary to preserve Medicaid's fiscal integrity.

"Each of these rules is vitally important to ensure the integrity of the Medicaid program," Smith said. "(They guarantee that) Medicaid beneficiaries are receiving the services for which Medicaid is paying, that those services are effective . . . and that taxpayers are receiving the full value."

Waxman disagreed.

"These regulations are not about program integrity," Waxman said. "If they were, CMS would be refining guidance and improving accountability. Instead, they seek to prohibit services that have been successful for decades and cut funding that the Congress has specifically preserved. This is not careful surgery on Medicaid. This is reckless amputation."

Miller ended her testimony with a request for the committee.

"Please don't send people with mental illnesses back to places like the Springfield State Hospital. We fought too hard and we've come too far to go back now."

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