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Honor the memory of Michelle Go: fix a broken system

Last year, a 40-year-old New Yorker named Michelle Alyssa Go was tragically pushed to death in front of a subway train in Times Square. The culprit was Martial Simon, a 61-year-old drifter who suffered from schizophrenia and had wandered around hospitals, prisons and psychiatric outpatient programs for decades without receiving the long-term treatment he needed.

While Michelle’s death shocked the city, seeing Simon’s name in the headlines didn’t surprise the countless healthcare workers who had tried to help him over the years. Even though the doctors we were aware that he stopped taking his medication when he was not supervised, there was little the hospital staff could do due to the shortage of beds.

But that’s not his fault. Rather, it is because federal law prohibits Medicaid from covering long-term stays for adults receiving mental health, substance use disorder (SUD), or addiction treatment in a medical center with more than 16 beds for such treatment.

This prohibition, the Institutions for Mental Diseases (IMD) exclusion, has been in place since Congress created Medicaid in 1965, resulting in the inability of patients like Simon to access care if they cannot afford these services themselves. themselves.

As a former federal prosecutor and now congressman, and as a physician and patient advocate, we know two things: 1) hospitals and care facilities want to help patients, but all too often are unable to due to restrictions beyond their control, including the exclusion of IMD; and 2) those with mental health issues like Simon often want help but cannot get it, contrary to popular belief, and are often victims of violence themselves.

Ultimately, while most homeless and mentally ill people do not pose a threat to public safety, the exclusion of IMD means that the vicious cycle of poverty and homelessness prevents many from getting the help they need. and wish.

There is a possible solution: the Michelle Alyssa Go Act, which Congressman Goldman will introduce at this Congress. The bill repeals the IMD exclusion, allowing Medicaid to reimburse facilities with more than 16 beds, providing equal access to essential long-term care.

This is a common-sense and much-needed policy correction to an outdated ban that has been a major roadblock for patients experiencing a mental health crisis here in New York and across the country.

Due to outdated provisions like the IMD exclusion, hospitals are not receiving the resources they need to handle urgently needed intensive and long-term care for those struggling with mental health issues. And because of decades-long cutbacks in psychiatric beds, these vulnerable people are often trapped in a broken, revolving-door system of “care”: they are given medication to temporarily alleviate symptoms before being released back onto the streets, only to show up again in crowded emergency departments.

The Michelle Alyssa Go Act is not just a function of improving hospital capacity; it also addresses an important equity issue in the law. With a limited supply of beds due to the Medicaid ban, people without financial means are often left without proper care. As mental health access advocates have pointed out for years, existing law clearly discriminates against the poor.

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As we move forward with the Michelle Alyssa Go Act, we recognize that there are legitimate concerns that repealing the IMD exclusion could lead to a return to mass institutionalization, which was the original impetus for this law more than half a century ago. To address those concerns, this legislation, as currently written, creates a standard for facilities and institutions to meet nationally recognized, evidence-based standards for mental health or SUD programs.

We intend to work with experts from across the spectrum of care, disability and homeless rights and mental health advocates to ensure that we are delivering a bill shaped by the real experiences of those who will be more affected.

We also intend to garner bipartisan support and bring this bill to President Biden’s desk.

This bill is certainly not a panacea for solving the mental health crisis we face in New York and across the country. Experts in the field recognize that hospital treatment is often only as good as the chronic and transitional care that patients receive.

But the Michelle Alyssa Go Act is a critical first step on the path to solving the root causes of mental health problems facing poor and underserved members of our city and country.

We must commit to honoring the memory of Michelle Go by closing the gaps in our mental health care infrastructure that could have saved her life. This legislation will do just that.

Goldman represents New York’s 10th district which covers downtown and part of Brooklyn. Roy is a medical addiction specialist and the Medical Director of Housing Works.

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