November 1, 2005

Targeted Case Management Under Fire in the House and Senate

Both the House and Senate are in the process of considering legislative proposals affecting Medicaid with the goal of achieving $10 billion in savings over the next five years. The House and Senate bills differ from each other, and both contain provisions that would limit the ability of community-based providers to deliver essential services to persons with mental illness.

Summary
According to a February 14, 2005 report issued by the Congressional Research Service, all 50 states draw down federal Medicaid dollars through the Targeted Case Management (TCM) option to finance intensive case management services to targeted populations (e.g., persons with AIDS,tuberculosis, chronic medical/surgical conditions, and developmental disabilities). Virtually every state in the Union specifically targets persons with mental illnesses for this benefit usually referring to this population as chronically mentally ill. In general, case management is absolutely essential to maintaining individuals with mental disorders in the community and out of state psychiatric hospitals.

Practically speaking, these services are a critical component of the overall architecture of mental health care necessary to sustain the hope of recovery for millions of Americans.

What's The Threat To Case Management?
Both bills have TCM provisions and the wording is extremely vague. According to the Congressional Budget Office, these provisions will cut case management spending by $750 million over 5 years and $2 billion over 10 years. The fear of the National Council is that these savings will be achieved by shifting the cost of case management services to cash strapped state, county and municipal governments.

What Should You Do? CALL YOUR REPRESENTATIVES AND SENATORS NOW BY DIALING 202-224-3121.Ask to be connected to your congressmans office or one of your senators, and then ask to speak with the health legislative assistant and say the following:

• The National Governors Association (NGA) opposes the Targeted Case Management provisions in the House and Senate budget bills because governors fear that the end result will be a cost shift to state and county government for these essential services.
• I am concerned that the TCM provisions contradict the tenants of President George W. Bushs New Freedom Commission on Mental Health, which call for helping people to recover from mental illnesses by INTEGRATING care.not scattering funding across state and county medical, educational and social service programs.
• It is impossible to sustain person with mental illnesses in the community and out of state psychiatric facilities without at least the current level of Medicaid case management funding.

URGE CONGRESS TO STRIKE THE TARGETED CASE MANAGEMENT PROVISIONS IN THEIR ENTIRETY OR NARROW THEIR SCOPE SIGNIFICANTLY.