The nationwide opioid crisis has propelled scrutiny in Congress of a longstanding federal rule that restricts the use of Medicaid at large-scale residential treatment facilities.
The same law limits Medicaid payments for inpatient mental health treatment at some types of facilities — a regulation Vermont has sidestepped for decades through a waiver.
Some experts advocate lifting the restriction from using federal money in large facilities for mental health care, saying it will increase much-needed psychiatric treatment capacity. Others are wary, saying the policy is moving the country toward a better system of mental health treatment.
Vermont lawmakers and regulators are moving ahead with a plan to expand the state’s mental health treatment system, which would involve building a new inpatient psychiatric facility at the Central Vermont Medical Center. Because it is a general services hospital, as many as 69 psychiatric beds could be added and services there would qualify for Medicaid. That far exceeds the number of beds the state and UVM Health Network plan — or need — to add.
One of the challenges for the mental health system in Vermont has been limitations on what funding can be used for, when things like housing, transportation and job services are key parts of a community-based system.
Mark Covall of the National Association for Behavioral Health Care said the organization has been urging changes to the federal bed limit.
When the law was put in place, patients were held in state hospitals for long periods of time. Now, he said, that practice is no longer used. But the rule remains and is barring people from accessing short-term care when they need it.
“It is harming patients because it is an arbitrary barrier to getting the care that they need,” he said.