Self care

Expanding Medicaid will improve Oklahomans’ mental health

Oklahoma is in crisis. While need for mental health care climbs, Oklahomans overwhelmingly lack access to the care needed to address these sometimes preventable, always treatable conditions. This has serious consequences: Untreated mental illness can mean increased risk for other health problems, incarceration, difficulty keeping a job and keeping up with financial responsibilities, and homelessness.

Many people experiencing a mental illness enter our criminal justice system because of that illness. In 2017, 10,000 individuals with a mental illness passed through the county jail in Tulsa alone. Other outcomes are more tragic: Our suicide rate increased 45 percent between 2009 and 2016. Oklahoma ranks eighth in the nation for incidence of suicide, according to American Foundation for Suicide Prevention.

Accepting federal funds for Medicaid expansion is the most practical way to address this crisis. Expanding Medicaid allows states to provide access to care to adults who earn up to 138 percent of the federal poverty level ($16,753 per year for an individual). More than 150,000 Oklahomans will gain access to health care through Medicaid expansion. This includes some of the 97,000 uninsured Oklahomans with a mental health diagnosis—roughly the entire population of Broken Arrow.

Oklahoma currently ranks 46th in the nation in spending on mental health care. Funding for mental health services in Oklahoma has never been adequate, but cuts over the last four years were particularly devastating. The Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS), the primary provider for low-income, uninsured adults, lost $52.6 million in state funding between 2014 and 2018, resulting in a loss of $80.4 million in matching funds from the federal government and deep cuts in services and provider rates. ODMHSAS will receive an $11 million increase in 2019, but this increase is only the beginning of restoring what was cut.

Without investment in health care, it is difficult—at times impossible—for people with a mental illness to get treatment. Only one in three Oklahomans who experience any form of mental illness get the care they need. People with less severe mental health problems are turned away and asked to come back when they are sicker and closer to—or actually in—crisis, at a risk of harming themselves or others. By the time they finally get the help they need, it’s far more resource and time-intensive, and often less effective than early
intervention.

Mental health care is improving in states that expanded Medicaid, making it easier for people who need care to get it, compared to non-expansion states like Oklahoma. Fewer people with depression are uninsured after Medicaid expansion, and those individuals also report fewer delays in care and fewer barriers to getting medication after getting coverage. Compared to non-expansion states, expansion states cut the number of mental health hospital stays nearly in half. Medicaid expansion also reduces deaths due to suicide and substance abuse, which commonly co-occur with a mental health diagnosis.

Every year, Oklahoma accepts federal funding for transportation, education, food assistance, and health care. In 2015, federal funds comprised nearly 40 percent of the state’s budget. Oklahomans’ federal tax dollars are being used to improve and expand healthcare in other states while Oklahomans are turned away from the care they need. It is time to accept federal dollars for Medicaid expansion and invest in the health and wellness of our own communities.

Lauren Turner is a mental health policy analyst with Oklahoma Policy Institute.