For those of you who have no idea what I am talking about, those are the supposed last words of Marie Antoinette, shortly before she and her head decided to take different vacations. They were said upon her being made aware of the fact that most of France was starving. There was very little famine at Versailles.

In 1965, the Johnson administration created what is now known as Medicare and Medicaid (Medi-Cal in California). Seemed like a good idea but they forgot about a large group of peasants. In this case, it was those who were mentally or emotionally disabled.  In 1965, most of those folks were in large institutions, now known as “Institutions for Mental Disease” (IMD’s).  Because some of these IMD’s were unhappy places, the people in Washington thought if they did away with them, then the people who lived had there would be happier. What could possibly go wrong? People said “we don’t want warehouses for these people. It will make everyone happier.”

Wrong. If you want to know when the explosion in homelessness started look to 1965.  As of that date, Federal law (Sec. 1905 (a)(B); Social Security Act) precluded paying for mental health care through Medicaid or Medi-Cal.  So folks with real mental health needs who could not afford private care or hospitals went where?  Not the VA. Not public hospitals. Not care homes. They went to the streets. So we now simply “warehouse” them on the street. Admit it, you have observed that many indigent folks on the street need mental health care and you say to yourself “why can’t we get these people help”?

The reason is simple. Most of the homeless are on Medi-Cal, but because of the IMD exclusion in the law, Medi-Cal cannot be used to pay for care for many who need it.  Both Federal and state governments share the blame. Neither one of them want to go near fixing this. There have been attempts made, as recently as this year, but no gains.

So today’s outrage is that people who REALLY need help can’t get it because of an archaic law that sounded good 60 years ago. Beware the law of unintended consequences. Ask you federal legislator when this will change. When will the IMD exclusion be removed? When will those with mental health issues get the help they need? Does anyone care?

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