In their Dec. 30 op-ed column, "Federal Neglect of the Mentally Ill," D. J. Jaffe and Mary Zdanowicz of the Treatment Advocacy Center state that the "Institution for Mental Diseases (IMD) exclusion prohibits Medicaid from reimbursing for most individuals who need care in a psychiatric hospital." They further claimed, "If you have a disease in your brain and need care in a psychiatric hospital, Medicaid does not [cover it]." Wrong.

While it is true that the exclusion applies to facilities that have more than 16 beds--for instance, those huge, antiquated state psychiatric hospitals--Medicaid does reimburse states billions of dollars for inpatient psychiatric care. Through Medicaid's DSH program, states receive reimbursements for hospitals serving a "disproportionate share" of people below certain income levels. Medicaid reimburses the hospitals--as opposed to individuals--because everyone in a state psychiatric hospital meets the low-income criteria.

Last year the federal government made $4 billion in DSH payments for state psychiatric hospitalization. Added to the $7 billion that states spend, the figure for state psychiatric hospital care is about $11 billion annually.

The Treatment Advocacy Center's op-ed writers propose the same old unworkable solutions. We need to talk about how to provide long-term and acute inpatient psychiatric care with the focus on closing old hospitals in favor of a more effective system that integrates inpatient care with the community mental health system.

RUTH HUGHES

CEO, International Association of

Psychosocial Rehabilitation Services

Columbia