This study reviews Medicaid policies to restrict access to psychiatric medications. Policies on prior authorization, preferred drug lists, limitations on the number of prescriptions, fail-first requirements, and use of generics are reviewed. All states apply one or more of those policies to medications for mental illness, and many apply several. A large number of states have legislated exemptions from those policies for certain medications, particularly antipsychotics and antidepressants. Other psychiatric medications are less well protected. Some states appear to restrict access severely. Questions have been raised as to whether these policies actually save money in the long term.
This publication examines various federal programs that can provide assistance in meeting the educational, vocational and basic supports needs of youth and young adults (from ages 16 to 30) with serious mental health conditions (SMHCs). It briefly examines the breadth and scope of available assistance and offers recommendations to improve state, local and federal policy. The information is intended for a diverse audience including policymakers, those assisting youth and young adults (family members and professionals) and individuals and groups that advocate for improved public policy. the imperative fOr Change Youth with SMHCs are often unprepared for the transition to adulthood and for participation in the labor force. In today's economy, gaining a firm footing on a career path is hard for most anyone, but it is particularly difficult for those with SMHCs. Overall, individuals with these conditions are more likely to drop out or be expelled from school and to forego higher education and job training when compared to a cohort of peers with disabilities of all types. Even more marked are the disparities in outcomes between those with SMHCs and the general population of their peers.
To date, 48 states have received federal grant aid and=or technical assistance for Olmstead planning initiatives that require consumer involvement in both planning and implementation. While most states have reported their current status in the development and implementation of Olmstead plans, few have reported on their involvement of consumers. This study addressed two questions: (1) What were the state's major accomplishments in the implementation of Olmstead as of 2005, and (2) What was the consumer involvement in Olmstead planning and implementation? To answer the research questions a multilevel, multistate study of Olmstead planning and implementation activities and consumer input was undertaken. Two surveys were developed: one to measure state stakeholder assessment of Olmstead activities; and one to measure consumer perception of inclusion in Olmstead activities and of the success of the Olmstead initiative. To the extent that states were able to implement their Olmstead plans many reported positive outcomes; for many states, however, the ability to fully implement their plans was curtailed by reductions in funding. Stakeholders and consumers have different impressions of the Olmstead initiat-ive, yet both identified similar positive outcomes. While other initiatives and interventions have occurred since the early days of Olmstead, such as the recovery movement and state-level service integration, it appears that Olmstead has served as the impetus for coalescing, at a critical time, the funding, mandate, and support necessary to support considerable innovation in the development of community living. The recommendations made by both the stakeholders and the consumers underscore the need for more funding, more housing, more community support services, such as employment, and more meaningful consumer involvement in the development and delivery of services.
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