A series of legal obstacles are preventing psychiatric hospitals in Baltimore and throughout the state of Maryland from assisting countless sufferers of mental disabilities and substance abuse disorders. Together, Governor Hogan and Baltimore Health Commissioner Leana Wen are rallying awareness and support for an exemption from federal laws which they feel are crippling Baltimore’s overburdened psychiatric hospitals.
Under current laws, the federal government will not issue any grant money to support substance abuse treatments for the majority of Marylanders who are seeking treatment options in residential facilities. This measure is called the federal Institutions for Mental Disease (IMD) Exclusion, and it specifically prevents any adult between the ages of 21 and 64 from using Medicaid to receive care for “mental diseases”, which is what substance abuse disorders are classified as.
On June 30th, Governor Hogan and the Maryland Department of Health and Mental Hygiene filed for a waiver to be released from the IMD Exclusion. Under their proposal, the city of Baltimore would be able to use Medicaid to funds to pay for residential facilities that have been successfully proven to consistently combat substance abuse rates over the years. That is to say, Baltimore City “hospitals, nursing facilities, and other institutions of more than 16 beds” with positive performance rates will be legally allowed to accept Medicaid for patients with substance abuse disorders and other mental diseases.
The waiver also contains an additional provision requesting the federal government to match funds for two statewide programs. The first program focuses on helping pregnant woman who are considered to be at “high risk” for health complications, as well as providing assistance for the children (up to age 5). The second program seeks to find “limited housing support services” for up to 250 Marylanders who are enrolled in Medicaid.
That same month, Baltimore Health Commissioner Wen testified before Congress on behalf of her city and state. Channeling her fellow city officials’ frustrations, the Commissioner questioned Congress by asking, “Can we channel our angst about addiction and mental health into a national plan that will make us the global model for treating patients with urgency, rigor, and humanity . . . Can we go beyond ‘whack a mole’ emergencies and implement a sound preparedness plan for health that makes our nation safer?”
Commissioner Wen’s words to Congress helped amend the “Buprenorphine Final Rule”, a federal law which strictly limited the number of patients that a health practitioner may prescribe buprenorphine (suboxone) to for opioid addiction. Whether her views will have the same enlightening effect on Congress pertaining to the IMD Exclusion remains to be seen.
The IMD Exclusion is not the only legal point of contention within Baltimore’s psychiatric industry. The Maryland Department of Health and Mental Hygiene became the center of a class-action lawsuit on June 9th for turning away criminal defendants who were ordered by a court into psychiatric treatment.
Under state law, when someone is accused of a crime but there remains doubts about that person’s mental ability to stand trial, then the individual must undergo treatment and psychiatric evaluation. These cases are handled by state-run psychiatric hospitals. However, these hospitals are often unable to accept new patients because they are already operating at full capacity. As a result, the mentally ill either are housed with the local jail population, or the judges choose to dismiss the less severe cases to prevent overcrowding the jails with mentally incompetent violators with minor infractions.
When a judge asked the Department to give a reason why they should not be held in contempt of court for disobeying a court order to place inmates under psychiatric care, the Department explained that they are experiencing a shortage of beds, and cannot afford to expand their facilities. A final legal decision has yet to be reached.