Quirks in Medicaid Funding Leave ‘Dual Diagnoses’ Patients in Lurch

Some Coloradans are diagnosed with a developmental disability, which can include Down’s syndrome, autism and cerebral palsy, while others are diagnosed with mental illnesses, which can include everything from depression to schizophrenia.

However, for people with the dual diagnoses of both developmental disability and mental illness, getting treatment means navigating an almost impossibly fragmented system in the state, a study has found.

Funding quirks have created huge gaps in care. As a result, family members find themselves alone — and often isolated — in trying to manage complex problems that need professional support, according to an ongoing study by JFK Partners, a program that does research on developmental disabilities at the University of Colorado School of Medicine.

As Rocky Mountain PBS I-News reported recently, the number of Coloradans affected isn’t small. Nationally, around one in three people with a developmental disability also has a diagnosis of some form of mental illness, according to a frequently-cited study by the National Association of State directors of Developmental Disabilities Services. That would translate to around 35,000 people in the state with dual diagnoses.

Most people with both developmental disabilities and behavioral health conditions are covered by Medicaid. But in Colorado, the public insurance treats the two diagnostic categories under incompatible payment systems – the first as fee-for-service, and the second as managed care.

Many are left without adequate care, and some without any care at all.

Expensive visits to the emergency room—which often provide little help except for short-term stabilization—have become a primary line of defense.

Many families are left to hope that the latest state-commissioned study will lead to a change in the way that people with complex developmental and mental health diagnoses are treated, that there will be a new path toward coordinated care.

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