Bill Overview
Title: To amend title XIX of the Social Security Act to make permanent the State plan amendment option to provide medical assistance for certain individuals who are patients in certain institutions for mental diseases, and for other purposes.
Description: This bill permanently allows state Medicaid programs to receive federal payment for substance-use disorder services that are provided at institutions for mental diseases (IMDs) for individuals aged 21 to 64. The bill also extends the maximum length of stay over a 12-month period from 30 days to 45 days. In addition, the bill provides statutory authority for a 2018 letter from the Centers for Medicare & Medicaid Services that provided for Medicaid demonstration programs for IMD mental health services for adults and children; the bill similarly increases the average length of stay under such programs to 45 days.
Sponsors: Rep. Burgess, Michael C. [R-TX-26]
Target Audience
Population: Individuals aged 21 to 64 requiring substance use disorder services in IMDs
Estimated Size: 10000000
- The bill directly impacts individuals aged 21 to 64 who require substance-use disorder services and who are patients in institutions for mental diseases (IMDs).
- The bill affects state Medicaid programs which will receive federal payments for these services, potentially impacting individuals who rely on Medicaid for their health coverage.
- The bill expanded the length of stay in IMDs from 30 days to 45 days in a 12-month period, which directly impacts patients who may require extended care.
- As of 2021, the National Survey on Drug Use and Health estimated that approximately 21 million people in the United States aged 12 or older needed substance use treatment of some kind. A portion of these individuals would fall into the 21 to 64 age group and be impacted by the bill.
- The United States Census Bureau data indicates that the global population aged 21 to 64 is substantial, considering that in 2023 the world population exceeded 8 billion.
Reasoning
- A significant number of people in the target demographic rely on Medicaid for access to IMDs due to substance use disorders. The policy potentially increases access to critical treatment services by extending covered stays. This can lead to variations in wellbeing improvements based on personal and contextual factors such as severity of disorder, financial situation, and overall health.
- The policy budget must account for the population size, estimated to be millions. With a limited budget, the policy cannot fully cover all who may benefit immediately, leading to prioritization of services, possibly impacting wellbeing unevenly initially.
- There is an expectation of positive shifts in wellbeing due to extended access to care in IMDs, but benefits may vary across different demographics based on pre-existing access levels and personal circumstances regarding substance use challenges.
- We've included individuals with varying levels of need and impact, resonating with typical outcomes of health policy implementations, which often show mixed results across different population subgroups.
Simulated Interviews
Construction worker (Ohio)
Age: 28 | Gender: male
Wellbeing Before Policy: 4
Duration of Impact: 20.0 years
Commonness: 3/20
Statement of Opinion:
- I think this policy is a lifesaver. I've needed longer stays in treatment before, and it could really help me get back on my feet.
- Staying longer in the facility means I can focus on recovery without worrying about being kicked out early because of cost.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 7 | 5 |
| Year 5 | 8 | 5 |
| Year 10 | 9 | 5 |
| Year 20 | 8 | 4 |
Social worker (California)
Age: 45 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 4/20
Statement of Opinion:
- It's a great step forward. Many people in my line of work could benefit from the extended stay coverage.
- This policy can make a significant difference in long-term recovery success for those I work with and myself included.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 8 | 6 |
| Year 10 | 8 | 6 |
| Year 20 | 7 | 5 |
IT consultant (New York)
Age: 34 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 5.0 years
Commonness: 5/20
Statement of Opinion:
- This could be beneficial for those who need hospitalization, which isn't my situation yet but good to know it's there if needed.
- Coverage for longer stays might mean less stress for friends who need more support.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 7 | 6 |
| Year 10 | 7 | 6 |
| Year 20 | 6 | 6 |
Stay-at-home mom (Florida)
Age: 52 | Gender: female
Wellbeing Before Policy: 3
Duration of Impact: 15.0 years
Commonness: 2/20
Statement of Opinion:
- The policy offers a better chance for my daughter to get the treatment she needs without rushing her out.
- I hope this means she can stay long enough to truly benefit and come home healthier.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 4 | 3 |
| Year 2 | 5 | 4 |
| Year 3 | 5 | 4 |
| Year 5 | 6 | 4 |
| Year 10 | 7 | 5 |
| Year 20 | 6 | 4 |
Student (Texas)
Age: 23 | Gender: other
Wellbeing Before Policy: 4
Duration of Impact: 10.0 years
Commonness: 3/20
Statement of Opinion:
- Losing my insurance has been stressful, but if Medicaid covers longer stays, it might be a path forward for me.
- It feels like a safety net that can really help while I try to stabilize.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 6 | 4 |
| Year 5 | 7 | 5 |
| Year 10 | 7 | 5 |
| Year 20 | 6 | 4 |
Retail manager (Tennessee)
Age: 39 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 0.0 years
Commonness: 6/20
Statement of Opinion:
- I support the bill for those who need it, but it doesn't impact me personally.
- It seems like a necessary step for those struggling with these issues.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 7 |
| Year 3 | 7 | 7 |
| Year 5 | 7 | 7 |
| Year 10 | 7 | 7 |
| Year 20 | 7 | 7 |
Retired (Illinois)
Age: 58 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 0.0 years
Commonness: 7/20
Statement of Opinion:
- It's good to know this service will be around for others, but at my age, I don't see it affecting me.
- As a former caregiver, I see the value if my grandchild ever needs help.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 5 |
| Year 2 | 5 | 5 |
| Year 3 | 5 | 5 |
| Year 5 | 5 | 5 |
| Year 10 | 5 | 5 |
| Year 20 | 5 | 5 |
Freelance Artist (North Carolina)
Age: 31 | Gender: female
Wellbeing Before Policy: 3
Duration of Impact: 8.0 years
Commonness: 4/20
Statement of Opinion:
- If I can get onto Medicaid, this policy would relieve a lot of pressure.
- Longer eligible stays could help many dealing with prolonged issues like myself.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 4 | 3 |
| Year 2 | 4 | 3 |
| Year 3 | 5 | 4 |
| Year 5 | 6 | 4 |
| Year 10 | 6 | 4 |
| Year 20 | 5 | 3 |
Factory worker (Missouri)
Age: 48 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 5.0 years
Commonness: 5/20
Statement of Opinion:
- I might not be directly impacted, but more comprehensive coverage options are always positive for our community.
- It means options are there should I need them in the future.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 6 | 5 |
| Year 5 | 6 | 5 |
| Year 10 | 6 | 5 |
| Year 20 | 5 | 5 |
Administrative Assistant (New Mexico)
Age: 36 | Gender: female
Wellbeing Before Policy: 8
Duration of Impact: 0.0 years
Commonness: 6/20
Statement of Opinion:
- This policy helps community members who need it, which improves our whole community well-being to some extent.
- While personally unaffected, I support the broader social benefits.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 8 |
| Year 2 | 8 | 8 |
| Year 3 | 8 | 8 |
| Year 5 | 8 | 8 |
| Year 10 | 8 | 8 |
| Year 20 | 8 | 8 |
Cost Estimates
Year 1: $1500000000 (Low: $1100000000, High: $2000000000)
Year 2: $1550000000 (Low: $1130000000, High: $2050000000)
Year 3: $1600000000 (Low: $1150000000, High: $2100000000)
Year 5: $1700000000 (Low: $1200000000, High: $2250000000)
Year 10: $1800000000 (Low: $1300000000, High: $2500000000)
Year 100: $2200000000 (Low: $1600000000, High: $3000000000)
Key Considerations
- The policy's success relies on states' willingness to expand services within IMDs significantly.
- Availability of qualified healthcare professionals to staff these expanded services is crucial.
- Federal budget impacts are contingent on states expanding coverage and usage.
- Possible state-level variations in implementation may affect cost estimates.
- Balancing costs with the potential benefits of reduced untreated substance-use disorder prevalence is essential.