Medicaid payments barely keep hospital mental health units afloat. Federal cuts could sink them

Spencer Hospital CEO Brenda Tiefenthaler (second from left) vows to support nan facility's intelligence wellness services, pinch thief from behavioral wellness services head Kerri Dandy (left), nursing head Jen Dau (third from left) and outreach navigator Jill Barr. Tony Leys/KFF Health News hide caption

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Tony Leys/KFF Health News

SPENCER, Iowa — This town's infirmary is simply a holdout connected behalf of group going done intelligence wellness crises. The facility's leaders person pledged not to shutter their inpatient psychiatric unit, arsenic dozens of different U.S. hospitals have.

Keeping that committedness could soon get tougher if Congress slashes Medicaid funding. The associated federal-state wellness security covers an unusually ample stock of intelligence wellness patients, and infirmary manufacture leaders opportunity spending cuts could accelerate a decades-long activity of psychiatric portion closures.

At slightest 8 different Iowa hospitals person stopped offering inpatient intelligence wellness attraction since 2007, forcing group successful situation to activity thief astatine distant facilities. Spencer Hospital is 1 of nan smallest successful Iowa still offering nan service.

CEO Brenda Tiefenthaler said 40% of her hospital's psychiatric inpatients are covered by Medicaid, compared pinch astir 12% of each inpatients. An further 10% of nan hospital's psychiatric inpatients are uninsured. National experts opportunity specified disparities are common.

Tiefenthaler vows to support her nonprofit hospital's 14-bed psychiatric portion open, moreover though it loses $2 cardinal per year. That's a important nonaccomplishment for an statement pinch an overall yearly budget of astir $120 million. But nan group who usage nan psychiatric portion request aesculapian care, "just for illustration group who person thorax pains," Tiefenthaler said.

Medicaid covers wellness attraction for astir 72 cardinal Americans pinch debased incomes aliases disabilities. Tiefenthaler predicts that if immoderate of them are kicked disconnected nan programme and near without security coverage, much group will hold curen for intelligence wellness problems until their lives rotation retired of control.

"Then they're going to participate done nan emergency room erstwhile they're successful a crisis," she said. "That's not really a solution to what we person going connected successful our country."

Republican legislature leaders have vowed to protect Medicaid for group who request it, but they besides person called for billions of dollars successful cuts to areas of nan national fund that see nan program. President Trump has pledged to protect Medicaid while targeting "waste, fraud and abuse."

The U.S. already faces a heavy shortage of inpatient intelligence wellness services, galore of which were reduced aliases eliminated by backstage hospitals and nationalist institutions, said Jennifer Snow, head of authorities relations and argumentation for nan National Alliance connected Mental Illness. At nan aforesaid time, nan number of group experiencing intelligence wellness problems has climbed.

"I don't moreover want to deliberation astir really overmuch worse it could get," she said.

The American Hospital Association estimates that astir 100 U.S. hospitals person shuttered their inpatient intelligence wellness services successful nan past decade.

Such closures are often attributed to intelligence wellness services being much apt to suffer money than galore different types of wellness care.

"I'm not blaming nan hospitals," Snow said. "They request to support their doors open."

Medicaid mostly pays hospitals little rates for services than they person from backstage security aliases Medicare, nan national programme that mostly covers group 65 aliases older. And Medicaid recipients are peculiarly apt to request intelligence wellness care. More than a 3rd of nonelderly Medicaid enrollees person immoderate benignant of intelligence illness, according to a study from KFF, a nonprofit wellness argumentation statement that includes KFF Health News. Iowa has nan highest rate of intelligence unwellness among nonelderly Medicaid recipients, astatine 51%.

As of February, conscionable 20 of Iowa's 116 organization hospitals had inpatient psychiatric units, according to a state registry. Iowa besides has 4 freestanding intelligence hospitals, including 2 tally by nan state.

Iowa, pinch 3.2 cardinal residents, has a full of astir 760 inpatient intelligence wellness beds that are staffed to attraction for patients, nan authorities reports. The Treatment Advocacy Center, a nationalist group seeking improved intelligence wellness care, says that nan "absolute minimum" of specified beds would construe to astir 960 for Iowa's organization and that nan optimal number would beryllium astir 1,920.

"They really shouldn't beryllium successful jail"

Most of Iowa's psychiatric beds are successful metro areas, and it tin return respective days for a slot to travel open. In nan meantime, patients routinely hold successful emergency departments.

Sheriff's deputies often are assigned to carrier patients to disposable accommodation erstwhile curen is tribunal ordered.

"It's not uncommon for america to thrust 5 aliases six hours," said Clay County Sheriff Chris Raveling, whose northwestern Iowa region includes Spencer, a metropolis of 11,000 people.

He said Spencer Hospital's intelligence wellness portion often is excessively afloat to judge caller patients and, for illustration galore specified facilities, it declines to return patients who are convulsive aliases charged pinch crimes.

The consequence is that group are held successful jailhouse connected insignificant charges stemming from their intelligence unwellness aliases addictions, nan sheriff said.

"They really shouldn't beryllium successful jail," he said. "Did they perpetrate a crime? Yes. But I don't deliberation they did it connected purpose."

Raveling said authorities successful galore cases determine to clasp group successful jailhouse truthful they don't wounded themselves aliases others while awaiting treatment. He has seen nan problems worsen successful his 25 years successful rule enforcement.

Most group pinch intelligence wellness issues tin beryllium treated arsenic outpatients, but galore of those services besides dangle heavy connected Medicaid and could beryllium susceptible to fund cuts.

Jon Ulven, a scientist who practices successful Moorhead, Minn., and neighboring Fargo, N.D., said he's peculiarly worried astir patients who create psychosis, which often originates successful nan teenage years aliases early adulthood. If they're started correct distant connected medicine and therapy, "we tin person a melodramatic power connected that personification for nan remainder of their life," he said. But if curen is delayed, their symptoms often go harder to reverse.

Ulven, who helps oversee intelligence wellness services successful his region for nan multistate Sanford Health system, said he's besides concerned astir group pinch different intelligence wellness challenges, including depression. He noted a study published successful 2022 that showed termination rates roseate faster successful states that declined to grow their Medicaid programs than successful states that agreed to grow their programs to screen much low-income adults. If Medicaid rolls are reduced again, he said, much group would beryllium uninsured and less services would beryllium available. That could lead to much suicides.

Nationally, Medicaid covered astir 41% of psychiatric inpatients cared for successful 2024 by a sample of 680 hospitals, according to an study done for KFF Health News by nan financial consulting institution Strata. In contrast, conscionable 13% of inpatients successful those hospitals' crab programs and 9% of inpatients successful their cardiac programs were covered by Medicaid.

If Medicaid participants person intelligence crises aft losing their coverage, hospitals aliases clinics would person to dainty galore of them for small aliases nary payment.

"These are not able people. They don't person a batch of assets," said Steve Wasson, Strata's main information and intelligence officer. Even though Medicaid pays hospitals comparatively debased rates, he said, "it's amended than nothing."

Birthing units, which besides person been plagued by closures, look akin challenges. In nan Strata sample, 37% of those units' patients were connected Medicaid successful 2024.

Spencer Hospital, which has a full of 63 inpatient beds, has maintained some its birthing portion and its psychiatric unit, and its leaders scheme to support them open. Amid a captious shortage of intelligence wellness professionals, it employs 2 psychiatric caregiver practitioners and 2 psychiatrists, including 1 providing attraction via video from North Carolina.

Local resident David Jacobsen appreciates nan hospital's efforts to sphere services. His boy Alex was assisted by nan facility's intelligence wellness professionals during years of struggles earlier he died by termination successful 2020.

David Jacobsen knows really reliant specified services are connected Medicaid, and he worries that much hospitals will curtail intelligence wellness offerings if nationalist leaders trim nan program. "They're hurting nan group who request thief nan most," he said.

People connected Medicaid aren't nan only ones affected erstwhile hospitals trim services aliases adjacent curen units. Everyone successful nan organization loses entree to care.

Alex Jacobsen's family saw really communal nan request is. "If we tin study thing from my Alex," 1 of his sisters wrote in his obituary, "it's that intelligence unwellness is real, it doesn't discriminate, and it takes immoderate of nan champion group down successful [its] disfigured swirling drain."

KFF Health News is simply a nationalist newsroom that produces in-depth publicity astir wellness issues and is 1 of nan halfway operating programs astatine KFF — nan independent root for wellness argumentation research, polling, and journalism.