Without Medicaid expansion, many Oklahomans with mental health issues will go untreated, experts say (NewsOK)

By Jaclyn Cosgrove

 A framed portrait of Abraham Lincoln hangs prominently near Joshua Kraft’s bedroom door.

For Kraft, it’s a reminder of what he could be, what he wants to be.

 Although historians don’t agree across the board on how he suffered, it’s documented that Lincoln suffered some form of chronic depression.

For Kraft, that’s a motivator.

Kraft is one of an estimated 122,000 Oklahomans with mental health issues who would have qualified for Medicaid in Oklahoma if the program were expanded to include more low-income adults, according to a report from the American Mental Health Counselors Association.

Kraft, 26, of Pauls Valley, wants to run for office someday, but first, he must find a way to better control his chronic depression and anxiety. It likely would be easier if he could afford treatment, he said.

“According to the Affordable Care Act’s (marketplace), I signed up and went through that process, and they said I would qualify for state Medicaid,” Kraft said. “When you go to the state Medicaid website, due to Governor Fallin’s unwillingness to expand it, I don’t qualify.”

Oklahoma is one of about 21 states that have chosen not to expand their Medicaid programs, a key provision of the Affordable Care Act, also known as Obamacare.

Gov. Mary Fallin’s spokesman Alex Weintz said the governor chose not to expand Medicaid because the state cannot afford the funding commitment, which would pull state dollars away from other priorities, such as education and public safety.

“Mental health is a huge priority for Governor Fallin,” Weintz said. “She has fought tooth and nail to successfully increase the budget of the Mental Health Department to support suicide prevention, prescription drug treatment and counseling, the construction of crisis centers for those experiencing mental health emergencies, and other important programs.”

‘Coverage gap’

Under Medicaid expansion, the federal government would pay for 100 percent of the state’s cost of covering newly eligible enrollees for the first three years, from 2014 to 2016. After that, the amount of money the federal government pays decreases, reaching 90 percent by 2020. After 2020, the state would have paid 10 percent of newly eligible enrollee costs, while the federal government would have paid 90 percent.

In almost 30 states that are implementing Medicaid expansion, Medicaid covers many low-income adults younger than 65, such as an adult making up to about $16,000 or a family of four with an income of about $32,500, according to the Oklahoma Policy Institute.

Because the Affordable Care Act envisioned low-income people receiving coverage through expanded Medicaid, people below poverty are not eligible for federal health insurance marketplace subsidies, according to the foundation. Thus, in states not implementing the Medicaid expansion, some adults fall into a “coverage gap” of earning too much to qualify for Medicaid, but not enough to qualify for premium tax credits, according to the foundation.

Kraft currently is uninsured and has no income. Because of his depression and anxiety, Kraft has had trouble keeping a job.

He has tried, working as a cashier, an overnight grocery stocker, an employee at The Toy and Action Figure Museum, a police dispatcher, an employee at an insurance company, a car salesman and a sales person at a paint supply store.

Until he turned 26, Kraft was covered under his mother’s health insurance.

His mother, Sherry Kraft, whom he lives with, said it was easier to manage her son’s mental health issues when he had coverage.

“There’s times where we wonder if we’re going to make it to the end of the month, with me being the only income,” she said. “The medicines and doctor visits and stuff — it’s hard.”

The numbers

Oklahoma has the second-highest rate of adults with serious mental illness, and also any mental illness, in the nation, according to the federal Substance Abuse and Mental Health Services Administration.

Meanwhile, Oklahoma ranks seventh-lowest in state mental health funding, allocating less money per capita to mental health services than most other states, according to a Kaiser Family Foundation analysis.

The majority of adults — about 70 percent — who need treatment do not get it, according to the state’s mental health agency.

Mike Brose, executive director of the nonprofit advocacy group Mental Health Association Oklahoma, said without Medicaid expansion, that’s unlikely to change.

Many Oklahomans with mental illnesses will continue to wait in long lines and, when in crises, seek care in emergency rooms, the most inefficient and expensive form of treatment, Brose said. Additionally, Oklahoma will continue to have a shortage of mental health providers and also a lack of funding for preventive care, he said.

“Our very, very low-income, most vulnerable people will continue to do without, or if they do get sick enough, they’ll be admitted to a hospital, and the taxpayer and those of us who pay premiums will have to underwrite that fee because no one is there to pay for it,” Brose said.

Understanding illness

Since being diagnosed about six years ago, Joshua Kraft has had a hard time in helping his friends and family understand his chronic depression. There are days when he hardly leaves his room or bed.

But there are plenty of good days, too. Kraft has restarted college, taking courses at Oklahoma City Community College, and has hopes of running for state representative some day.

In the meantime, he hopes to help people understand mental illness and what it means to have chronic depression.

“It’s a feeling of hopelessness, loneliness, unhappiness,” he said. “You don’t really fit anywhere in particular in the world; you don’t know what you’re here for — it sucks, I’ll just be honest with you.”



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