Individuals in Medicaid Deserve Care That is Appropriate and Responsible in its Execution Act

Floor Speech

Date: June 20, 2018
Location: Washington, DC


Mr. KILDEE. Mr. Chairman, this legislation requires States to submit a report on the number of patients served for opioid use disorder at institutions for mental diseases, their length of stay, and the care they received after they were discharged. My amendment would add two requirements to that report.

The first additional element addresses co-occurring disorders. My amendment would require that States include information on the number of individuals suffering from these disorders, as well as the type of specific disorders from which they suffer.

Co-occurring disorders are a terrible situation in which a person is simultaneously experiencing a mental illness and a substance use issue. This is especially prevalent in our veteran population, with the VA estimating that about one-third of veterans seeking treatment for substance use disorder also meet the criteria for post-traumatic stress disorder.

Co-occurring disorders can be especially difficult for doctors to diagnose because of how complex symptoms can be, with one often masking the symptoms of the other.

As of 2016, the Substance Abuse and Mental Health Services Administration estimates that more than 8 million adults in the U.S. had co-occurring disorders. Half of them did not receive proper treatment, and around one-third received no care for mental illness or substance use disorder.

If we are going to get these individuals the help they need and deserve, we are going to need to know what care is needed and how large the existing treatment gap really is. My amendment will help to provide that data.

The second element of my amendment requires information on access to community care for individuals suffering from a mental illness other than substance use disorder.

For decades, our country has shifted mental healthcare services away from institutional care into community health providers. That is substantial progress that we certainly don't want to reverse or endanger.

Make no mistake, passing this legislation will have a direct effect on access to community care for people with mental diseases. We should know how much and to what extent that is the case. My amendment will provide Congress with the data on whether that access is increasing or, as a result of this potential legislation, decreasing.

We should not, in efforts to combat this epidemic, inadvertently create uncertainty or greater harm for other groups of people, especially such vulnerable groups as those with mental illness. My amendment will provide Congress with greater information for us to know if we are doing just that.

Mr. Chairman, I urge my colleagues to support this amendment, and I reserve the balance of my time.

Mrs. MIMI WALTERS of California. Mr. Chairman, I claim the time in opposition, but I am not opposed to the amendment.


Mr. KILDEE. Mr. Chairman, I appreciate the comments of both of my colleagues.

This is an effort to make sure that, as we take on this epidemic, whatever path we may take, we do so in a way that gets us the best information we can to determine whether or not we are making the progress that this intends. We have our thoughts about that. This legislation, and this particular amendment, would ensure that Congress has the information it needs.

I encourage my colleagues to support the amendment, and I yield back the balance of my time.