Evaluation of the Medicaid Emergency Psychiatric Services Demonstration (MEPD)

The 1986 Emergency Medical Treatment and Labor Act (EMTALA) requires any psychiatric hospital that participates in Medicare and has available capacity to accept appropriate transfers of individuals found to have emergency medical conditions (EMCs) that require specialized psychiatric service capabilities, regardless of the individual’s ability to pay. Medicaid statute, however, prohibits provision of federal Medicaid matching funds for inpatient care provided in “institutions for mental disease” (IMDs) for individuals aged 21 to 64, even for services provided to beneficiaries with EMCs.

As a result, in states that do not cover the costs of inpatient treatment for Medicaid beneficiaries in private IMDs through state-only funds, private IMDs may be required to provide uncompensated treatment to Medicaid beneficiaries with psychiatric EMCs. During the past ten years, frequent boarding of psychiatric patients in emergency rooms (ERs) and nonpsychiatric beds of general hospitals (referred to as scatter beds) has been reported to occur when specialized inpatient psychiatric beds are not available. Stakeholders have suggested that the IMD exclusion may contribute to boarding of Medicaid beneficiaries with psychiatric EMCs in ERs and scatter beds as Medicaid beneficiaries are at a disadvantage in the competition for scarce inpatient beds relative to other patients with insurance that will pay for treatment in IMDs.

Through this demonstration, 11 states and the District of Columbia received federal Medicaid matching funds for inpatient treatment in participating private IMDs for beneficiaries with psychiatric EMCs, defined as being suicidal, homicidal, or dangerous to oneself or others. As mandated by the Affordable Care Act, the evaluation addressed the following areas:

• Medicaid inpatient access, length of stay, and emergency room visits
• Discharge planning by participating hospitals
• Impact on costs of the full range of mental health services, including inpatient, emergency, and ambulatory care
• Percentage of individuals admitted to participating IMDs as a result of the demonstration compared with those admitted to the same facilities through other means.