Bill Overview
Title: Michelle Alyssa Go Act
Description: This bill removes certain limitations relating to Medicaid coverage of services provided in institutions for mental diseases (IMDs). Current law generally prohibits federal payment under Medicaid for services provided in IMDs with more than 16 beds for individuals under the age of 65 (although states may receive payment through certain mechanisms, such as through a Medicaid demonstration waiver). The bill removes the age limitation and allows any institution to qualify as an IMD, regardless of the number of beds, if it primarily treats individuals with mental diseases and meets nationally recognized standards for mental health or substance use disorder programs, as approved by the Centers for Medicare & Medicaid Services.
Sponsors: Rep. Maloney, Carolyn B. [D-NY-12]
Target Audience
Population: people with mental diseases who require institutional care
Estimated Size: 11000000
- The bill affects Medicaid coverage, which is a public health insurance program in the United States primarily for individuals and families with low incomes.
- Currently, Medicaid doesn’t cover mental health services in large institutions (over 16 beds) for those under 65, due to the IMD exclusion.
- Removing the bed and age limitations means that more mental health institutions can receive funding from Medicaid, expanding access to mental health services.
- Individuals with mental diseases who require institutional care would be directly impacted as they could have better access to necessary and possibly more affordable care.
- Institutions that provide mental health services will be financially impacted as they can receive more funds and accommodate more patients.
- Families and caregivers of individuals with mental diseases might experience reduced burden due to increased access to appropriate care.
Reasoning
- The Michelle Alyssa Go Act aims to improve access to mental health services by removing IMD restrictions in Medicaid funding. This could significantly enhance the quality of care for individuals with severe mental illnesses that require institutional care.
- The policy will likely have a high impact on individuals who need long-term, inpatient mental health care and their families by alleviating financial burdens and improving access to care.
- The population most affected will include low-income individuals needing mental health services, which aligns with Medicaid’s target demographic.
- Some people may not be directly affected due to already having coverage or not utilizing institutional mental health care.
- This simulation considers a broad spectrum of impact, from those who will see significant positive changes in their well-being to those experiencing minimal change.
Simulated Interviews
Unemployed (New York, NY)
Age: 45 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 20.0 years
Commonness: 10/20
Statement of Opinion:
- I really need more consistent mental health services. It's hard to find a place that accepts Medicaid and has enough beds.
- If the policy allows more institutions to accept Medicaid, it could really improve my treatment access.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 4 |
| Year 2 | 7 | 4 |
| Year 3 | 7 | 5 |
| Year 5 | 8 | 5 |
| Year 10 | 8 | 5 |
| Year 20 | 9 | 5 |
Social Worker (Los Angeles, CA)
Age: 32 | Gender: male
Wellbeing Before Policy: 7
Duration of Impact: 5.0 years
Commonness: 15/20
Statement of Opinion:
- This policy could significantly expand treatment options for my clients who struggle to find affordable care.
- It will make a big difference for those who really need intensive inpatient care.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 8 | 7 |
| Year 3 | 8 | 7 |
| Year 5 | 8 | 7 |
| Year 10 | 8 | 7 |
| Year 20 | 8 | 7 |
Mental Health Advocate (Chicago, IL)
Age: 27 | Gender: other
Wellbeing Before Policy: 5
Duration of Impact: 15.0 years
Commonness: 12/20
Statement of Opinion:
- My sibling could really benefit from more mental health institutions being available through Medicaid.
- This bill is a step in the right direction, but proper implementation is key.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 8 | 6 |
| Year 5 | 8 | 6 |
| Year 10 | 9 | 6 |
| Year 20 | 9 | 6 |
Retired (Orlando, FL)
Age: 63 | Gender: female
Wellbeing Before Policy: 3
Duration of Impact: 10.0 years
Commonness: 9/20
Statement of Opinion:
- I'm overwhelmed with caregiving duties and finding a facility that will accept Medicaid for my husband has been difficult.
- If this allows us to get him more help, it will drastically improve our lives.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 3 |
| Year 2 | 6 | 3 |
| Year 3 | 6 | 4 |
| Year 5 | 7 | 4 |
| Year 10 | 7 | 4 |
| Year 20 | 7 | 4 |
Construction Worker (Houston, TX)
Age: 54 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 5.0 years
Commonness: 8/20
Statement of Opinion:
- I benefited a lot from my stay, but not everyone has the same opportunity due to Medicaid limits.
- This policy could help others get the help they need like I did.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 7 | 6 |
| Year 5 | 7 | 6 |
| Year 10 | 7 | 6 |
| Year 20 | 7 | 6 |
Freelance Artist (Seattle, WA)
Age: 34 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 3.0 years
Commonness: 18/20
Statement of Opinion:
- Knowing that friends can potentially access more facilities with Medicaid would ease some worry.
- Mental health care access has always been an issue in discussions among my circle.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 6 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 7 | 6 |
| Year 10 | 7 | 6 |
| Year 20 | 7 | 6 |
Tech Analyst (Austin, TX)
Age: 29 | Gender: male
Wellbeing Before Policy: 8
Duration of Impact: 0.0 years
Commonness: 14/20
Statement of Opinion:
- This policy would likely not affect me directly given my current support situation.
- However, it's promising to see more access for those in critical need.
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 |
College Professor (Denver, CO)
Age: 50 | Gender: other
Wellbeing Before Policy: 4
Duration of Impact: 10.0 years
Commonness: 11/20
Statement of Opinion:
- The removal of bed limits would prevent situations like when my wife was denied and had to wait.
- It's a critical move towards accessible mental health care.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 4 |
| Year 2 | 7 | 4 |
| Year 3 | 7 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 7 | 5 |
| Year 20 | 7 | 5 |
Entrepreneur (San Francisco, CA)
Age: 40 | Gender: female
Wellbeing Before Policy: 8
Duration of Impact: 2.0 years
Commonness: 17/20
Statement of Opinion:
- I'm fortunate to access care easily, but I support this policy as many don't have that privilege.
- Medicaid expansion in mental health is necessary.
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 |
Nurse (Boston, MA)
Age: 38 | Gender: male
Wellbeing Before Policy: 7
Duration of Impact: 5.0 years
Commonness: 13/20
Statement of Opinion:
- Funding limitations are a constant topic. This policy promises necessary changes.
- Better funding means better care services, which I fully support.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 8 | 7 |
| Year 3 | 8 | 7 |
| Year 5 | 8 | 7 |
| Year 10 | 8 | 7 |
| Year 20 | 8 | 7 |
Cost Estimates
Year 1: $3500000000 (Low: $3000000000, High: $4000000000)
Year 2: $3750000000 (Low: $3150000000, High: $4350000000)
Year 3: $4000000000 (Low: $3400000000, High: $4600000000)
Year 5: $4300000000 (Low: $3700000000, High: $4900000000)
Year 10: $4800000000 (Low: $4100000000, High: $5500000000)
Year 100: $7500000000 (Low: $6900000000, High: $8100000000)
Key Considerations
- The exact cost will depend on the number of eligible institutions and individuals who will use the newly available Medicaid services.
- Coordination with state Medicaid offices will be necessary to implement these changes effectively and manage increased demand.
- Monitoring and evaluation will be key to ensuring that IMDs meet nationally recognized care standards.