Expanding the mental health safety net post-COVID

Biden's American Rescue Plan offers a significant opportunity for Florida to increase access for behavioral health needs

With the signing of the American Rescue Plan of 2021, the federal government is poised to make its most significant investment ever in mental health programs and other supports that impact individuals with mental health conditions. And not a minute too soon, as the growing behavioral health impact of the pandemic has begun to emerge in alarming statistics.

The plan includes more than $700 million dedicated to strengthening community, school and physician mental health and substance abuse services; bolstering the behavioral health work force; supporting health care workers and first responders’ mental well being; and expanding suicide prevention programs and the traumatic stress network.

Moreover, it boosts the incentive for Florida and the 11 other states that have been stubbornly resistant thus far to sign on to Medicaid expansion, providing an opportunity for healthcare coverage for all residents up to 138 percent of the federal poverty line. According to Health Care for Florida, the official campaign working to make Medicaid expansion a reality in the state, that means as many as 800,000 Floridians could receive coverage who currently have no access to any insurance plan or are only eligible for plans with high out-of-pocket costs.

The federal government previously offered 90 percent assistance with the cost of expansion, by returning states’ federal tax dollars to provide health care. The ADP offers an additional 5-percentage point increase in the base federal medical assistance percentage (or FMAP) for the first two years. Since expansion has already produced net savings in several states, this additional boon could cover not only Florida’s share of the coverage cost, but potentially free up state dollars to cover threatened cuts caused by the impact of the pandemic and economic crisis.

The Kaiser Family Foundation and the Center on Budget and Policy Priorities estimate Florida would receive between $3 billion and $3.5 billion additional dollars to fund health care through expansion. According to the Florida Policy Institute, Medicaid expansion would earn the state a total net savings of $198,995,000 in the first year alone.

For months, state legislators have projected a budget deficit of over $2 billion, including a projected $1.2 billion shortfall in general revenue for Medicaid, due to the economic crisis of the past year. Even before the pandemic, Florida bore a financial burden of $2.6 billion per year in uncompensated hospital care, contributing to escalating private insurance premiums and increasing hospital costs overall.

Yet the Florida legislature has stubbornly refused to even fully consider expansion, arguing against government-supported healthcare and insisting the private market place can do a better job without straining the state’s budget.

The impact of the pandemic on our collective mental health has already been documented in rising rates of anxiety, depression and suicide. The next two years — the length of the additional FMAP support — are sure to bring unprecedented mental health challenges and health care costs.

And while someone who is physically ill may go to the ER regardless of whether they have insurance or not, lack of insurance usually deters those with mental health challenges. That insures those problems will either go untreated and left to erupt in a costly crisis down the line, or be temporarily assuaged with destructive self-medication behaviors, causing a ripple stress effect that would also exponentially increase illness and costs.

Accepting this virtually “free” money for Medicaid expansion when the future need is so clearly evidenced seems like a no-brainer. Yet the two current Florida House bills aimed at expansion (HB 443/HB 341) have been referred to the Finance and Facilities Subcommittee where they have yet to be heard or debated. In light of the current mental health crisis, such ongoing resistance seems not only inexplicable, but intentionally malicious.

Signing on to expansion would increase behavioral healthcare access for the hundreds of thousands of people who have fallen through the safety net, even before the past traumatic year. It’s long past time Florida legislators recognized that caring about all the state’s residents — not just those with the means to take care of themselves — would enhance not only their characters, but potentially the states bottom line as well.

HOW YOU CAN HELP

• Sign the Health Care for Florida petition at healthcareforfl.org.

• Contact your legislators, urging them to get behind HB 442 and 341 and demanding justification if they refuse

• Share your personal story at healthcareforfl.org/share