I have worked at Northwestern Community Services Board for almost 20 years.  I work primarily with adult clients and benefit eligibility.  Many of our clients receiving Social Security Disability Benefits for a serious mental illness have a monthly benefit amount ($1,064 - $1,436) that makes them ineligible for full Medicaid coverage.  Most of these clients would benefit from case management, psychosocial rehabilitation, and ACT services with a medical necessity determination.  They have to meet a very deductible amount every 6 months to satisfy their spend down amount.  Medicaid Expansion is providing full coverage to low income individuals through the Medicaid Managed Care Organizations.  An individual can have a monthly income of $1, 481 and qualify for Medicaid coverage.  Medicaid Expansion members may or may not have a debilitating serious mental illness and yet, they are able to access targeted case management services for assistance in linkage to community resources, attend/participate in psychosocial rehabilitation programs, and receive ACT services if more intensive services are required.  When providers such as CSBs, provide these needed services to those with Medicare/Medicaid spend downs, there is no reimbursement in most instances due to the difficulty of meeting these very high 6 month spend down amounts.  These individuals with SMI's would benefit greatly by having access to the Medicare non-covered mental health services, and providers could be reimbursed for such services.

Thank you,

Dixie Wilson

Eligibility Benefits Specialist/Credentialing Specialist/NWCSB