One of the variables when talking about Medicaid expansion that deserves attention is the process of how Medicaid patients receive treatment for mental illness. As of January 2013, non-traditional Medicaid recipients in Weber, Davis, Salt Lake and Utah counties were enrolled into one of four Accountable Care Organizations (ACO). Instead of patients seeing their primary care physician for their mental illness, a scenario that is more common than not, they must now go to the county-managed Community Mental Health Center (CMHC). Part of the confusion that providers are dealing with is ambiguity with what constitutes mental illness.

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Although the safety net for patients with mental illness exists, it is anything but efficient. Just this last year, Valley Mental Health, Utah's largest CMHC, purged roughly 2,200 patients from its system because offices were overrun with patients. This leaves patients without a provider to care for them until they can get seen at the CMHC. The other alternative is sending patients to the ER because they can and will be seen.

How will these patients receive care? Who will see them? Regardless of how ethical or noble the Medicaid expansion is, the current system should allow primary care providers to treat their patients with mental illness. Any expansion without this will only make things worse.

Daniel Peck

Woods Cross