Hundreds of thousands of Americans with serious mental illness sleep in jails, shelters, and prisons on any given night. Fewer than 40,000 are in state psychiatric hospitals.
This is largely due to federal policy, the Institutions for Mental Disease Exclusion, which created a financial incentive for states to kick the mentally ill out of hospitals.! How the hell can this happen, you ask?
The IMD Exclusion, part of the 1965 law that established Medicaid, prevents the program from funding care for mentally ill adults while they live in hospitals or even adult homes with more than 16 beds.
These small “institutions” were the bedrock of the mentally ill who would need long term health care, but the costs were staggering!
So, what did our lawmakers do?? They dressed up their problems in their Sunday best and threw their collective asses out in the street! The budgetary requirements for the 1965 Medicare/Medicaid would shit can any hopes for this portion of the federal governments’ power grab from the states… so, they mistakenly believed that newly developed antipsychotic drugs and community mental health centers would obviate the need for institutions.
It’s been a disaster. Before Medicaid was enacted, states paid for psychiatric hospitalization, and it was readily available. But states soon realized that if they kicked patients out of hospitals, Medicaid would kick in and pay half the cost of care. This “deinstitutionalization” continues and the result is the larger part of the “homeless population” is a result.
The IMD Exclusion is turning business districts into homeless camps, forcing police to run shadow mental-health systems, causing chaos for families of mentally ill adults, and driving up costs. Yes, it can be fixed… but it hasn’t!
So, you’ve got Johnson, Nixon, Ford, Carter and Reagan…Bush, Clinton, Bush, and Shit Stain… not one of these fuckers did a thing about it! As my Jewish friends say “lozn sey geyn”. I’ll have you look that one up, just to see if you are paying attention! Until… until…wait for it… wait for it… YES PRESIDENT DONALD J. TRUMP!! Old Fearless steps up and puts up his budget that would end a 55-year ban of Medicaid funding for institutional care!
However… you guessed it… it’s stalled in Congress. So, next time your heart is moved by these poor folks plight, remember… President Trump is the only president since 1965 that took the initiative.
Johnson Long
