This article summarizes a Report to Congress concerning Medicaid limits on assistance for patients in institutions for mental diseases (IMDs). There is little or no basis for changing this policy. Court judgments have found that the policy's application has been reasonable and consistent with congressional intent. Also, the general trend in the alcohol, drug abuse, and mental health (ADM) service system has been in outpatient or partial care, not institutional care. Research supports the conclusion that alternatives to IMD treatment are the most cost-effective. Finally, eliminating the IMD policy would be expensive, and simply substitute federal for state funding.
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Alcohol, Drug Abuse, and Mental Health Administration. (1990).National Drug and Alcoholism Treatment Unit Survey, 1989 (DHHS Publication No. ADM 91-1729). Rockville, MD: Author.
Anglin, M. D., & Hser, Y. (1990). The efficacy of drug abuse treatment. In M. Toury & J. Q. Wilson (Eds.),Drugs and crime. Chicago: University of Chicago Press.
Annis, H. M. (1986). Is inpatient rehabilitation of the alcoholic cost effective? Con position.Advances in Alcohol and Substance Abuse, 5, 175–190.
Braun, P., Kochansky, G., Shapiro, K., Greenberg, S., Gudeman, J. E., Johnson, S., & Shore, M. F. (1981). Overview: Deinstitutionalization of psychiatric patients, a critical review of outcome studies.American Journal of Psychiatry, 138, 736–749.
Cross, T., Saxe, L., & Hack, M. (1988).The effectiveness of treatment settings for cocaine and other non-opiate drugs. Waltham, MA: Bigel Institute, Heller School, Brandeis University.
Department of Health and Human Services, Health Care Financing Administration. (1992).Report to Congress: Medicaid and institutions for mental diseases (HCFA Publication No. 03339). Baltimore, MD: Author.
Green, L. R., & De La Cruz, A. (1981). Psychiatric treatment as an alternative to and transition from full time hospitalization.Community Mental Health Journal, 17, 191–202.
Kiesler, C. A., & Sibulkin, A. E. (1987).Mental hospitalization. Newbury Park, CA: Sage Publications.
Manderscheid, R. W., & Sonnenschein, M. A. (Eds.). (1990).Mental health, United States, 1990 (DHHS Publication No. ADM 90-1708). Washington, DC: U.S. Government Printing Office.
Miller, W. R., & Hester, R. K. (1986). Inpatient alcoholism treatment: Who benefits?American Psychologist, 41, 794–805.
Omnibus Budget Reconciliation Act of 1989, Pub. L. No. 101-239, §6408.
Pennsylvania Department of Public Welfare. (1989). Departmental Appeals Board Decision No. 1042, Department of Health and Human Services. April 24, 1989.
Pub. L. No. 81-734 (1950).
Pub. L. No. 92-603 (1972).
Saxe, L., & Goodman, L. (1988). The effectiveness of outpatient vs. inpatient treatment: Updating the OTA report. Paper presented to the Prudential Insurance Co., Roseland, NJ.
Social Security Act §§ 1902(a)(10), (a)(16), and 1905(h) (1991a).
Social Security Act § 1905(a)(24)(B) (1991b).
Social Security Act § 1905(i) (1991c).
Social Security Amendments of 1965, Pub. L. No. 89-97 (1965).
State Medicaid Manual. Services to individuals age 65 or older in institutions for mental diseases, §4390 and §4390.1, Health Care Financing Administration (1990).
State of Connecticut Dept. of Income Maintenance v. Heckler, 471 U.S. 524 (1985).
Taube, C. A. & Barrett, S. A. (Eds.). (1983).Mental Health, United States, 1983 (DHHS Publication No. ADM 83-1275). Washington, DC: U.S. Government Printing Office.
Taube, C. A. (1990). Funding and expenditures for mental illness. In R. W. Manderscheid, & M. A. Sonnenschein (Eds.),Mental Health, United States, 1990 (DHHS Publication No. ADM 90-1708). Washington, DC: U.S. Government Printing Office.
Vischi, T. R., Jones, K. R., Shank, E. L., & Lima, L. H. (1980).The alcohol, drug abuse and mental health national data book (DHHS Publication No. ADM 80-938). Rockville, MD: U.S. Department of Health and Human Services.
Wright, G. E., & Buck, J. A. (1991). Medicaid support of alcohol, drug abuse, and mental health services.Health Care Financing Review, 13(1), 117–128.
Richard Frank and David Salkever of Johns Hopkins University provided cost estimates and expenditure information.
The views presented in this paper are those of the Department of Health and Human Services and not necessarily those of the authors.
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Buck, J.A., Kiesler, C.A., Ashman, T.D. et al. Medicaid limits on support of institutional psychiatric care. Adm Policy Ment Health 22, 573–580 (1995). https://doi.org/10.1007/BF02254821
- Public Health
- Mental Health
- Drug Abuse
- Mental Disease