Planned Closure of Three More Maryland Mental Health Clinics Puts Patients ‘At Risk’

The lives and health of about 74,000 Maryland residents with mental illnesses have become "imperiled" as several clinics close or refuse to accept new patients because of funding problems, the Washington Post reports. In Montgomery County, "one of the wealthiest counties in the nation," four clinics last year declared bankruptcy and ceased operations; now three additional clinics are "struggling" to remain open in part because of state underfunding. Because of the closings, about 3,400 Montgomery County residents are "at risk." The problem stems from how the state pays for treatment of residents with mental illnesses. Patients who have illnesses severe enough to qualify as a disability are eligible for coverage under Medicare; the program covers only half of a psychiatrist's bill and not medications. Other patients with low incomes might qualify for Medicaid, which covers all needed care and medications. Remaining patients either have private coverage or are uninsured. Until 1996, Maryland had covered the remaining 50% of bills for Medicare beneficiaries who were dually eligible for Medicaid. When the state ended that practice, many patients were unable to pay the portion of their bills that Medicare did not cover. In 1997, the state initiated an "ambitious program" -- not explained by the Post -- to "cover more people at lower cost." However, officials "greatly underestimated" -- at 40,000 -- the number of people who would access services. About 80,000 people sought treatment under the pgoram.

Providers Deal with Low Reimbursements
Another part of the problem is that reimbursements from the state are often delayed and "at least" 15% below the cost of care, mental health providers say. Montgomery County Executive Douglas Duncan (D) said, "Clearly, the state needs to meet its financial obligation to provide mental health services. They've underfunded that dramatically. If that continues, we're going to see more and more mental health services shut down." Of the eight remaining clinics in Montgomery County, all are "unable to pay their expenses," the Post reports. Because of the funding issues, clinics that are being forced to shut down are attempting to help their patients find care elsewhere. However, many private doctors are unwilling to take patients who are uninsured. Some clinics are cutting costs by switching from individual therapy to group sessions, even though most patients request and require individual treatment. Oscar Morgan, director of Maryland's Mental Hygiene Administration, said, "We're taking a hard look at this. We have something on the table to enable a strategic plan." The Sun reports that Morgan said he would have a plan within the week, but did not say what it would include (Hedgpeth, Washington Post, 1/15).