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In Tuesday’s Expert Perspective, Mark Covall discussed Medicare’s 190-day limit for inpatient care for mental illness. Today, we offer a bit of background on this confounding—and life-threatening—limit.

Fear and Politics

Eliminating the 190-day lifetime limit on has been on the stove—albeit not the front burner—for more than two decades.

The limitation originated in the Social Security Act of 1965, when Medicare came into being. In 1965, people feared mental illness; they were biased against psychiatric hospitals and those who received care there. Combined with political strife over whether the states or the federal government should bear the costs of that care, this bias could explain the arbitrary and discriminatory limit.

Despite numerous changes in mental health care administration, medical practice, insurance, and—arguably most important—perceptions and understanding of mental health conditions, the 190-day lifetime limit persists.

And to get rid of it, there needs to be a change to federal law.

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Mark J. Covall
President and CEO, National Association of Psychiatric Health Systems

Medicare denies specialty inpatient care for mental illness but not any other medical condition.

Over the past few years, we’ve made great strides in eliminating barriers to mental health treatment. In 2008, Congress passed the Mental Health Parity and Addiction Equity Act, which requires private insurers to cover mental health and addiction treatment at the same level as other medical disorders.

However, lawful discrimination against mental illnesses still exists for seniors and disabled adults who receive benefits through Medicare.

That’s because Medicare beneficiaries have a lifetime limit of 190 days of inpatient psychiatric hospital care. There is no such lifetime limit for any other Medicare specialty inpatient hospital service.

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Distance-Related Challenges
In Tuesday’s Expert Perspective, Ron Manderscheid outlined three common kinds of challenges to accessing mental health care: insurance-related, provider-related, and distance-related challenges. We’ve heard first-hand from Jennifer and Doug how these barriers have impeded their access to mental health care.

Today we hear from Brandy, whose distance-related and other challenges are not uncommon for people who live in rural areas and elsewhere.

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Provider-Related Challenges
In Tuesday’s Expert Perspective, Ron Manderscheid outlined three common kinds of challenges to accessing mental health care: insurance-related, provider-related, and distance-related challenges. Yesterday we heard from Jennifer, who experienced the first of these roadblocks, and tomorrow we’ll hear yet another story from someone who experienced these barriers first-hand.

Today’s story is from Doug. His provider-related challenges may sound familiar to you: he was denied access to quality care because a provider stopped seeing individuals on Medicare.

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Insurance-Related Challenges
In yesterday’s Expert Perspective, Ron Manderscheid outlined three common kinds of challenges to accessing mental health care: insurance-related, provider-related, and distance-related challenges. Over the next three days, we’ll hear personal stories from individuals who’ve experienced these roadblocks first-hand.

Today, we hear from Jennifer, who, like many of you, experienced insurance-related challenges first-hand.

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Do you remember the scene in Harry Potter and the Order of the Phoenix when Harry and his friends were trying to find their way to the Department of Mysteries in the Ministry of Magic?

The group arrived at a circular hall with several doors. The doors kept changing places, and the group’s progress was halted. Finding the right door was made almost impossible—aside from the fact that they weren’t entirely sure what they were looking for—by uncontrollable circumstances...

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How are you affected?

Estimating Impact
Mental Health America projected more than 1.13 million Americans could lose access to any kind of public mental health support.

The White House warned that “up to 373,000 seriously mentally ill adults and seriously emotionally disturbed children could go untreated. This would likely lead to increased hospitalizations, involvement in the criminal justice system, and homelessness for these individuals.”

One article termed the sequester to be a “mental health crisis,” noting that some sequestration-related spending cuts had potential to be more devastating than others, both for individuals and society. For example, “a furlough for a Reston, Virginia, Defense Department worker doesn’t have the same consequences as it does for a young man with severe bipolar disorder waiting an extra month to see a psychiatrist.”

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