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Bar News - February 17, 2016

Opinion: Ensuring Mental Health and Addiction Treatment Through Medicaid Expansion

The NH Health Protection Program, which now provides access to healthcare for more than 47,000 people in our state, will sunset later this year, unless the NH Legislature enacts a bill to reauthorize it. The program is New Hampshire’s version of Medicaid expansion – a unique, Granite State solution to providing healthcare to all our citizens with a bridge to the private marketplace. NAMI-NH and the NH Community Behavioral Health Association both strongly supported the 2014 legislation creating the program, and we now urge legislators to pass HB 1696, the bill that will keep it going.

NAMI-NH is the state branch of the National Alliance on Mental Illness, the grassroots organization for individuals and families dealing with mental illness; and the NH Community Behavioral Health Association represents the state’s community mental health centers. Our organizations are committed to ensuring that all New Hampshire citizens have access to mental health care and substance abuse and addiction treatment. The NH Health Protection Program has helped to guarantee that. More than 70,000 people have used the program over the past two years, which demonstrates that this is a true hand-up for working people, not a hand-out. Most of the people using the program are the working poor.

The National Institute on Health estimates that one in five people has a mental illness, yet only about 50 percent of those affected seek help. Like any other illness, delaying treatment for mental illness or a substance use disorder creates a clinical problem: By the time an individual is in need of this level of care, their illness has likely worsened because they were not treated in the early stages, in an appropriate setting. This often results in extended stays in hospital emergency departments, for up to a week, while patients wait for an inpatient bed so they can receive the acute care they need. Hospital ERs are only able to focus on the immediate crisis, to stabilize individuals, not to address their longer-term, chronic conditions or problems.

Access to health insurance means people receive care in a more timely and appropriate way. This is more compassionate, humane and clinically recommended; it also saves money.

Not reauthorizing the NH Health Protection Plan will shift the costs of providing health care to the uninsured to other payers; this will increase both commercial health insurance premiums and Medicaid costs. It will also mean that New Hampshire’s community-based mental health system will be further strained by providing services to uninsured individuals.

As anyone who follows the news knows, New Hampshire is in the throes of a serious opioid and substance use disorder crisis. Addiction puts pressure on individuals and their families, and significantly and negatively impacts schools, courts, corrections, child protective services, and other costly state and community agencies. The NH Health Protection Plan offers a benefit for substance use disorder services and is therefore the front line in our efforts to stem the current drug crisis. This benefit is especially critical for individuals with both a mental illness and a co-occurring substance use disorder, who often have increased rates of hospitalization, incarceration, homelessness, complicated medical conditions, suicide and drug overdoses. The NH Health Protection Plan improves outcomes for those with co-occurring conditions and helps reduce medical costs.

On the side of medical ethics, we want to add our personal observations that nothing puts families under more emotional and financial duress than serious medical conditions. The NH Health Protection Plan has helped lessen that stress for many of our fellow citizens and neighbors, by providing access to healthcare coverage – which means early detection and appropriate treatment of medical conditions, mental illness and substance use disorders.

The NH Health Protection Program has given our state the opportunity to create a more equitable system of care. Keeping 47,000 enrollees insured helps the market and keeps costs down for all of us by increasing the size of the risk pool. And finally, it helps individuals with mental health and substance use problems get proper care for their conditions so that the other parts of their lives – family, work, housing, education and meaningful participation in the community – are not limited or stifled.

Annette Carbonneau is director of adult and family programs for NAMI-NH. Suellen M. Griffin is president of the NH Community Behavioral Health Association and president/CEO of West Central Behavioral Health in Lebanon.

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