Financing the care of the mentally ill under Medicare and Medicaid.

Abstract

I NCLUSION of psychiatric benefits in the Social Security Amendments of 1965 represents a significant precedent in financing care of the mentally ill. The two programs-Medicare and Medicaid essentially removed the economic barriers to quality medical care for the aged and poor whose health care needs were greatest but who often were receiving less. Although mental health care services were not emphasized in the legislation, the mental health benefits and special limitations specified in the law have brought into sharper focus the policy issues and problems relating to the provision of more adequate mental health services for the entire population of the country. The special limitations that govern the availability of Medicare and Medicaid benefits for the mentally ill reflect the concern of Congress with the fiscal and policy implications of covering the long-term custodial care commonly associated with the mental hospital. Various representatives from public programs and private groups testified before the Senate Finance Committee during its hearings on the Social Security Amendments of 1967 with respect to the limitations on coverage of care of the mentally ill under Medicare and Medicaid. Following the 1967 hearings, the Senate Finance Committee requested the Secretary of the Department of Health, Education, and Welfare to study the experience under the 1965 Amendments to the Social Security Act and to make recommendations for changes in the current provisions in a report to the committee by January 1, 1969.1 An ad hoc task force, consisting of the staff of the Social Security Administration, the Social and Rehabilitation Service, and the Health Services and Mental Health Administration, has been engaged in a comprehensive study of the use of covered services by psychiatric patients under Medicare and Medicaid. It was recognized that information on the extent of utilization of services is essential for evaluating the effects of the existing psychiatric benefit limitations. The data requirements, however, could not be fully met within the time period specified by the Senate