Judge David L. Bazelon Center for Mental Health Law, Washington, D.C.
Psychiatr Serv. 2021 Aug 1;72(8):880-884. doi: 10.1176/appi.ps.202000252. Epub 2020 Dec 18.
Housing is critical to enabling people with serious mental illnesses to live successfully in their communities. Yet unlike other essential community-based services, housing cannot be covered under the Medicaid program, which guarantees states federal reimbursement for between 50% and 83% of the cost of services. Instead, service systems rely on federal housing assistance programs and, where available, on state or local housing subsidy programs. Mental health service systems could make housing more widely available if they could use federal Medicaid funds for housing. The federal government has not provided Medicaid reimbursement for housing because of Medicaid's exclusion of "room and board," but it has recently granted Medicaid demonstration waivers that lift a similar statutory prohibition: the institutions for mental disease (IMD) exclusion rule, which bars Medicaid payments for services to individuals ages 21 to 64 in psychiatric institutions. If the government approves demonstration waivers of the IMD exclusion, it should similarly approve demonstrations covering housing for people with serious mental illnesses. If these demonstrations show that providing Medicaid financing for housing improves mental health outcomes and reduces use of more costly services, those results should spur a conversation about modifying Medicaid to allow reimbursement for housing in appropriate circumstances.
住房对于使患有严重精神疾病的人能够成功地在社区中生活至关重要。然而，与其他基本的社区服务不同，住房不能被纳入医疗补助计划（Medicaid program）覆盖范围，该计划保障了各州对服务费用的 50%至 83%的联邦报销。相反，服务系统依赖于联邦住房援助计划，以及在可用的情况下，依赖于州或地方住房补贴计划。如果精神卫生服务系统能够将联邦医疗补助资金用于住房，那么它们可以使住房更加普及。联邦政府没有为住房提供医疗补助报销，因为医疗补助排除了“食宿”，但它最近批准了医疗补助示范豁免，取消了类似的法定禁令：精神疾病机构（IMD）排除规则，该规则禁止为 21 至 64 岁的精神病患者在精神病院接受服务支付医疗补助。如果政府批准 IMD 排除的示范豁免，它也应该批准涵盖为严重精神疾病患者提供住房的示范项目。如果这些示范表明为住房提供医疗补助融资可以改善心理健康结果并减少对成本更高的服务的使用，那么这些结果应该会引发关于在适当情况下修改医疗补助以允许住房报销的讨论。
