LITTLE ROCK — Expanding Medicaid coverage to 250,000 poor Arkansans could improve services for unstable mentally ill people in Arkansas - a group responsible for some of the violent outbursts that have plagued the country in recent years, state Department of Human Services Director John Selig told lawmakers Wednesday.
For the first time in speaking to lawmakers, Selig linked Medicaid expansion and the debate over gun violence and mental illness that has dominated national news since the Dec. 14Sandy Hook Elementary school shooting in Newtown, Conn., left 20 children and six adults dead.
Selig said most violence isn’t committed by the mentally ill, but a small subgroup of “unstable” people in Arkansas aren’t getting the treatment they need to keep themselves and others safe.
“We’re not able to track them, keep them stable, like we’d like,” Selig told members of the Senate Public Health, Welfare and Labor Committee.
The state spends about $15 million in state money on adult mental-health services. If the Legislature approves Medicaid expansion, then about two-thirds of this troubled population would have health coverage, Selig said.
Medicaid coverage would also free up federal dollars to strengthen crisis-intervention and community-based services, he said.
“To make sure they’re taking meds, make sure they’re stable, before there is a more serious issue,” Selig said.
Selig’s comments came in a presentation to senators about major Medicaid issues.
Adult mental-health services involve treatment for mental illness and substance abuse in the State Hospital, community health centers and the Arkansas Health Center, a psychiatric nursing home in Saline County, said Amy Webb, Department of Human Services spokesman.
About 110,000 adults and children use behavioralhealth services in the state. The agency doesn’t have an estimate of how many of those people would beeligible for Medicaid expansion, Webb said.
Republican Sen. Missy Irvin of Mountain View asked Selig what his agency is doing to root out people who fraudulently receive Medicaid benefits.
Adults have to meet stringent asset verification tests, Selig replied, but children currently can be placed on ARKids, the Medicaid health-coverage program for children from low-income families, without verification of their economic status other than their parents’ word.
A new system that links Department of Human Services databases with other federal databases will soon allow the department to more easily determine family income, he said.
The state’s newly started Medicaid payment overhaul, which shifts payments from the traditional fee-forservice model to payments based on statistical averages for specific “episodes of care,” has prompted providers to transform their billing practices even before they are directly affected by the fix, begun in October, Selig said.
The shift has slowed Medicaid spending to its lowest rate in 25 years. An improving economy also has helped slow Medicaid growth, he said.
The improving fiscal outlook means a projected deficit of $138 million might be reduced by tens of millions of dollars, Selig said after the meeting.
Level 3 nursing care, which would affect up to 15,000 frail senior citizens who need help walking, eating or using the bathroom, are no longer in danger of being eliminated, he said.
Medicaid expansion needs to be approved by three-quarters of the Legislature. Most observers expect the issue to dominate the session, but likely not to be decided before the end of the session.
On a day when President Barack Obama signed two-dozen executive orders aimed at reducing gun violence and promised to introduce sweeping guncontrol measures to Congress, Selig didn’t explicitly mention the Sandy Hook shootings in committee, but afterward he responded to reporters’ questions about the link.
“There has been a lot of talk about gun control, but there is also talk about improving mental-health services for our adults because there are situations when people with serious mental illness are involved in these violent acts,” Selig said.
Front Section, Pages 7 on 01/17/2013