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What would health-care expansion in Virginia mean for mental-health-care access?

Virginia Gov. Terry McAuliffe visited Inova Loudoun Hospital in Leesburg on Monday to try to rally support for his signature initiative this session — the expansion of Medicaid. (Sarah L. Voisin/The Washington Post)

Democratic Virginia Gov. Terry McAuliffe and lawmakers in the Republican-dominated House of Delegates are flirting with a government shutdown, having reached an impasse over whether to expand health insurance coverage for the poor.

That stalemate contrasts sharply with strong bipartisan and bicameral consensus over reforming the state’s mental-health-care system, following the tragic death of Austin “Gus” Deeds, son of Sen. Creigh Deeds (D-Bath) in November.

But it is hard to separate any discussion of mental-health-care access without talking about Medicaid, which accounts for about half of state controlled mental health funds.  On Wednesday, the state’s five major mental health advocacy groups, including NAMI of Virginia and Voices for Virginia’s Children, staked out a position in favor of expanding health-care coverage, a view shared by folks who run the state’s community service boards. Granted, advocates would probably prefer an expansion of Medicaid, but even supporters of the idea have given up on using the M-word.

The Senate proposal, which the House has already rejected, would still benefit the 77,000 uninsured Virginians with mental illness, the advocates said at a news conference in Richmond Wednesday.  That proposal to use federal dollars to help lower-income Virginians pay for private health insurance would help cover medication, therapy and inpatient hospitalization, said Mira Signer, executive director of NAMI of Virginia. And it could especially help younger adults who have aged out of Medicaid for children and who are not disabled enough to qualify for disability payments and do not earn to afford private health insurance, said Margaret Nimmo Crowe, executive director of Voices for Virginia’s Children.

The proposal would also inject hundreds of millions of dollars into community mental health services, which advocates say are key to preventing crises and keeping emergency psychiatric beds available for people who need them.

The Senate proposal would put at least ten times more money into the state mental health system than the $48 million mental health package in the House budget, Signer said.

She said there is “no way” Virginia can successfully reform its mental-health-care system without addressing the uninsured.

The Senate proposal also has the backing of the Virginia Hospital & Healthcare Association, which represents psychiatric, rehabilitation, and other specialty hospitals.

Opponents of the Senate proposal said they are leery of partnering with the federal government, which they foresee sticking Virginians with an ever increasing bill as the federal contribution drops over time. Lawmakers will try to hash out their differences next week.

Regardless of the outcome of that fight, there are still several mental health reforms such as extending the time local mental health workers have to find psychiatric beds for individuals in crisis, that are likely to pass. They would take effect in July — provided the government stays open.