The CEO des Spencer Hospital, Brenda Tiefenthaler (second from left), promises the psychiatric services of the facility with the help of the director for behavioral health service Kerri Dandy (left), the nurse Jen Dau (third from left) and Outreach Navigator Jill Sarr.
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Spencer, Iowa – The hospital of this city is an influence in the name of people through mental health. The leaders of the facility have undertaken not to close their inpatient psychiatric unit, as dozens of other US hospitals did.
The promise could soon become more difficult if the congress lowers the financing of Medicaid Finance. The state’s joint health insurance covers an unusually large proportion of patients with mental health, and the executives of the hospital industry say that expenses can accelerate a wave of psychiatric degrees for decades.
At least eight other hospitals in Iowa have stopped inpatient mental health care since 2007, and forcing people in the crisis to seek help in distant facilities. The Spencer Hospital is one of the little ones in Iowa that still offers the service.
CEO Brenda Tiefenthaler said 40% of the psychiatric inpatient patients in their hospital were covered by Medicaid, compared to around 12% of all inpatient patients. Another 10% of the hospital’s psychiatric inpatient patients are not insured. National experts say that such differences are common.
Tiefenthaler promises to keep the 14-bed psychiatric unit of its non-profit hospital open, even though it loses $ 2 million a year. This is a significant loss for an organization with one Total annual budget of around $ 120 million. But the people who use psychiatric unity need medical care, “just like people who have chest pain,” said Tiefenthaler.
Medicaid covers health care for around 72 million Americans with low incomes or disabilities. Tiefenthaler predicts that if some of them start the program and leaving them without insurance protection, more people delay treatment for mental health problems until their lives get out of control.
“Then you will take the emergency room when you are in a crisis,” she said. “This is not really a solution for what we have in our country.”
Republican congress leaders have sworn In order to protect Medicaid for people who need it, they also demanded billions of dollars in cuts in areas of the federal budget, which includes the program. President Trump has committed himself Protect Medicaid During the goal “waste, fraud and abuse”.
The United States already has a deep lack of inpatient psychiatric services, many of which have been reduced or eliminated by private hospitals and public institutions, said Jennifer Snow, director of government relationships and politics for the National Alliance for Mental Diseases. At the same time, the number of people who have psychological health problems climbed.
“I don’t even want to think about how much worse it could be,” she said.
The American Hospital Association estimates that almost 100 US hospitals have closed their inpatient psychiatric services in the past ten years.
Such closures are often due to the fact that psychiatric services are more likely to lose money than many other types of health care.
“I don’t blame the hospitals,” said Snow. “You have to keep your doors open.”
Medicaid generally pays lower tariffs for services than for private insurance or Medicare, the federal program, which mainly covers people aged 65 and over. And Medicaid recipients particularly need mental health care. More than a third of the non -older Medicaid participants have a kind of mental illness, According to a report by KFFA non -profit organization for health policy that contains KFF Health News. Iowa has the highest rate From mental illnesses in non -older Medicaid recipients at 51%.
As of February, only 20 of Iowas had 116 community hospitals inpatient psychiatric units, so A State register. Iowa also has four free -standing psychological hospitals, including two from the state.
With 3.2 million inhabitants, IOWA has a total of around 760 inpatient psychiatric beds that are occupied by the care of patients, the state reports. The treatment representative center, a national group that striven for improved mental health care, says that the “absolute minimum” would be such beds for the population of Iowa to around 960 and the optimal number of around 1,920.
“You really shouldn’t be in prison”
Most psychiatric beds from Iowa are in the U -Bahn areas, and it can take several days for a slot to be opened. In the meantime, patients are routinely waiting in emergency rooms.
The deputies of the sheriff are often assigned to transport patients into available facilities when the treatment is ordered.
“It is not unusual for us to drive five or six hours,” said Clay County, Chris Raveling, the northwest of Iowa County Spencer, a city with 11,000 people.
He said that the psychiatric unit of the Spencer Hospital is often too full to accept new patients, and how many such facilities rejects patients with violent or crimes.
The result is that people are recorded in prison because of minor charges who come from their mental illness or addiction, said the sheriff.
“You really shouldn’t be in prison,” he said. “Have you committed a crime? Yes. But I don’t think you have done it on purpose.”
In many cases, Raveling decides to keep people in prison so that they do not injure themselves or others while waiting for the treatment. He saw how the problems in his 25 years deteriorated in law enforcement.
Most people with mental health problems can be treated as outpatient patients, but many of these services are also very dependent on Medicaid and could be susceptible to budget cuts.
Jon Ulven, a psychologist who practiced in Moorhead, Minnesota, and the neighboring Fargo, ND, said that he was particularly concerned about patients who develop psychosis who often begin in the teenagers or in early adulthood. If you are started immediately with medication and therapy, “we can have a dramatic influence on this person for the rest of your life,” he said. However, if the treatment is delayed, your symptoms often become more difficult to reverse.
Ulven, who helps the multi -state of Sanford health system to monitor mental health services in his region, said that he was also concerned about people with other challenges for mental health, including depression. He noticed a study The suicide rates published in 2022 rose faster than in countries who agreed to expand their programs to extend more adults with low incomes in states that rejected their Medicaid programs. If Medicaid Rolls are reduced again, more people would not be insured and fewer services would be available. That could lead to more suicide.
According to an analysis for KFF Health News The Financial Consulting Company Straa, almost 41% of psychiatric inpatient patients in 2024 was looked after by a sample of 680 hospitals. In contrast, only 13% of inpatient patients were covered in the cancer programs of the hospitals and 9% of inpatient patients in their heart programs of Medicaid.
If Medicaid participants have mental crises after loss of their cover, hospitals or clinics would have to treat many of them for little or no payment.
“These are not wealthy people. They don’t have many assets,” said Steve Wasson, Chief Data and Intelligence Officer from Straa. Although Medicaid pays relatively low prices, he said: “It’s better than nothing.”
Birth units that have also been plagued by closingsare similar challenges. In the layer test, 37% of the patients of these units were on Medicaid in 2024.
The Spencer Hospital, which has a total of 63 inpatient beds, has retained both its birth unit and his psychiatric unit, and planned its leaders to keep them open. In the middle of a critical lack of experts in mental health, two psychiatric nurse and two psychiatrists are used, including one that is provided by North Carolina video.
The resident David Jacobsen estimates the efforts of the hospital to maintain services. His son Alex was struggled in years before he died of suicide in 2020, supported by the experts at the facility.
David Jacobsen knows how dependent such services are on medicaid, and he fears that more and more hospitals will restrict the mental health obligations if the national managers shorten the program. “They hurt the people who need the most,” he said.
People on Medicaid are not the only people affected if hospitals reduce services or close treatment units. Everyone in the community loses access to care.
Alex Jacobsen’s family saw how often the need is. “If we can learn something from my Alex,” wrote one of his sisters in His obituary“It is the case that mental illnesses are real, not discriminated and some of the best people take it in [its] ugly swirling drain. “
Kff Health News is a national news editor Kff – The independent source of health policy research, surveys and journalism.