KHI News Service

Nearly half of Missouri psychiatric beds could be cut without Medicaid expansion

State mental health department director says mental health crisis looms

By Mike Sherry | April 08, 2013

Keith Schafer, director of the Missouri Department of Mental Health, warned of a “hidden crisis” among mentally ill adults in the state if the state does not expand Medicaid as envisioned by the federal Affordable Care Act. He spoke to a group of health professionals on Friday at Metropolitan Community College-Maple Woods in Kansas City.

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Missouri could lose more than 40 percent of its hospital-based adult psychiatric beds if state lawmakers decide against expanding Medicaid, the director of the Missouri Department of Mental Health said Friday.

Keith Schafer estimated that hospitals would eliminate roughly 500 adult psychiatric beds if the General Assembly does not expand Medicaid eligibility to 138 percent. The issue is pending before lawmakers.

Schafer spoke to a group of health professionals at Metropolitan Community College-Maple Woods in Kansas City. The Health Care Foundation of Greater Kansas City organized the event.

Schafer said the total number of hospital-based beds for the adult population now stands at approximately 1,200 — which is about half of what was available two decades ago.

Truman Medical Centers’ Lakewood Campus in Kansas City has 28 adult psychiatric beds.

“If we don’t expand Medicaid,” Schafer said, “We (will) have a hidden crisis in acute psychiatric care like we have never seen in the state of Missouri. People will be desperate all over the state of Missouri.”

When the U.S. Supreme Court upheld the Affordable Care Act, it left it up to the states to determine if they wanted to expand Medicaid.

Sixteen states have decided to expand Medicaid, according to the Center on Budget and Policy Priorities. In Missouri, Democratic Gov. Jay Nixon supports expanding Medicaid, but the Republican-led legislature is balking.

Under the Medicaid expansion, the federal government has pledged to pay the full cost of newly eligible participants for the first three years of the expansion, starting next year. States would pay no more than 10 percent of those costs after that.

Missouri estimates the expansion would cover an additional 300,000 residents. That includes about 90,000 residents who are developmentally disabled or are mentally ill, including people with substance abuse problems, according to the Department of Mental Health.

“I’m more afraid of the downside...than I’m excited about the upside,” Schafer said.

Psychiatric beds likely to be cut

The potential bed closures, he said, would come because of the expected reduction in federal payments to hospitals that treat a significant number of indigent patients.

In passing the Affordable Care Act, Congress projected hospitals would need less of these funds because they would be treating more patients covered by Medicaid. In states that do not expand Medicaid, hospitals are facing a reduction in these “disproportionate share” payments without the corresponding increase in patients that have public insurance.

According to the Department of Mental Health, Missouri hospitals stand to lose half of the $500 million they collect in disproportionate share dollars. At Lakewood alone, according to the department, the loss would be about $10.6 million annually.

Schafer said hospital administrators would likely eliminate psychiatric beds because they account for a large percentage of the charity care that the federal government would no longer cover.

For instance at Lakewood, he said, psychiatric patients account for nearly half of all “charity days” provided by the hospital even though those beds make up less than 10 percent of the 310 beds in the facility.

Hospital administrators would have to look at inefficiencies like that in deciding where to save money, Schafer said.

A loss of those inpatient beds would make life difficult for an organization like Tri-County Mental Health Services, which serves Platte, Clay and Ray counties, said Tom Cranshaw, chief executive at the agency.

It would be a “real challenge” to serve acute patients that are now treated on an inpatient basis, Cranshaw said. “And we could not do it as effectively as the hospitals do it,” he said.

Cranshaw said agency leaders are in a holding pattern about what to do. “Once the decision is made...we will adapt accordingly either way,” he said.

Officials at the Jackson County Community Mental Health Fund are focusing on how they can best serve residents who would remain uninsured, even with a Medicaid expansion, said Theresa Cummings, director of program development.

The fund allocates about $11 million annually raised through a property tax levy.

She was disheartened to hear of resistance in the General Assembly to expanding Medicaid.

“It’s disappointing that legislators don’t understand the dire issues of a population that is not able to take care of themselves,” she said.

KHI News Service coverage of Medicaid expansion

Medicaid Access Coalition launches online "ticker" showing foregone federal dollars (2/13/14)
→ KHI report: Nearly 182,000 Kansans in the ‘Eligibility Gap’ (1/11/14)
House speaker says Medicaid expansion is "up to the governor" (1/10/14)
KS Senate president says Medicaid expansion unlikely to gain approval this session (1/7/14)
Profiles of the coverage gap: Kathleen Christian (1/6/14)
Efforts continue to expand Medicaid in Kansas and Missouri (1/6/14)
Hospital association hires former Bush HHS secretary to help craft a plan Kansas Republicans might support (12/23/13)
Iowa wins approval to expand Medicaid by using federal funds to buy private insurance (12/11/13)
White House officials hold call to urge Medicaid expansion in Kansas (11/21/13)
Republican governor talks up plan to expand Medicaid — his way (10/28/13)
Challenger says Brownback owes voters a decision on Medicaid expansion (10/22/13)
Nearly 5.2M Americans fall in coverage gap in states not expanding Medicaid (10/16/13)
Sebelius: Feds flexible on how states expand Medicaid (9/22/13)
Sebelius says Kansas and Missouri are missing the boat on Medicaid expansion (9/20/13)
Medicaid expansion coalition finds strength in numbers (9/17/13)
Republican Gov. Corbett proposes expanding Pennsylvania Medicaid (9/16/13)
Kansas lawmakers urged to consider Medicaid expansion by Wesley CEO (8/29/13)
Estimating maneuver could help more people gain from Obamacare: How the poor might qualify for Affordable Care Act subsidies in states that don't expand Medicaid (8/12/13)
Report: States not expanding Medicaid stand to benefit most from doing so (7/18/13)
CMS won’t penalize hospitals in states slow to expand Medicaid (5/14/13)
Insurer Centene: We can do Arkansas-style Medicaid (5/14/13)
The Arkansas Medicaid Model: What you need to know about the 'private option' (5/2/13)
Nothing to be done about coverage gap in states not expanding Medicaid, feds say (4/29/13)
Brownback says he's listening to Medicaid expansion proponents, opponents (4/5/13)
Oregon shows costs of putting Medicaid enrollees in private coverage (3/29/13)
Governor urged to expand Medicaid eligibility (3/27/13)
Arkansas Medicaid expansion attracts other states' interest (3/26/13)
Senate president prefers options remain open on Medicaid expansion (3/25/13)
States urged to expand Medicaid with private insurance (3/22/13)
Senate budget amendment underscores opposition to Medicaid expansion (3/21/13)
Study: Kansas employers face millions a year in possible penalties without Medicaid expansion (3/15/13)
More than 30 Kansas groups pushing for Medicaid expansion (3/12/13)
Health insurers see big opportunities in health law’s Medicaid expansion (3/8/13)
Medicaid expansion supporters to step up lobbying efforts (3/7/13)
Budget committee hears resolution opposing Medicaid expansion (2/22/13)
Legislators focusing on Medicaid expansion cost estimates (2/19/13)
Kansas hospital group study predicts expanding Medicaid would generate 4,000 jobs (2/18/13)
Brownback officials release their cost projections for Medicaid expansion (2/8/13)
Medicaid expansion bill introduced (1/22/13)
Kansas hospitals worried about loss of dollars for charity care (1/14/13)
Brownback compiling own estimate of Medicaid expansion cost (12/20/12)
Group urges Brownback to expand Medicaid eligibility (11/9/12)
Debate begins on possible Kansas Medicaid expansion (10/25/12)
Amerigroup CEO says states ‘need’ to go along with Medicaid expansion (7/11/12)
Kansas hospitals ready to get on with federal health reform, spokesman says (7/2/12)
Kansas AG claims partial victory in health reform case (6/29/12)
High court upholds Affordable Care Act, but ruling puts limits on Medicaid expansion (6/28/12)

→ Kansas Hospital Association: An opportunity for the Kansas Medicaid program
→ Americans for Prosperity-Kansas: Well-intentioned policies do more harm than good
→ Health Reform Resource Project: The cost of not expanding Medicaid
→ Rep. Jim Ward: Medicaid expansion essential for healthier Kansas
→ Rep. David Crum: Reasons for opposing Medicaid expansion
→ National Academy for State Health Policy: Much ado about Arkansas: Medicaid in the insurance exchange

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