Many are aware Colorado is in a dire crisis of mental health, substance use and homelessness. We see every day too many of our friends, family members and neighbors are experiencing difficulties. We see we don’t have the proper supports and safeguards in place to stop people from experiencing preventable worst outcomes. What most are unaware of, however, is how outdated and seemingly benign policies perpetuate this vicious cycle in which so many Coloradans are trapped.

We’re constantly seeing tragic stories play out in our communities. A person falls on hard times, experiences a mental health or substance use issue, or all of the above. Their health needs go unmet, and before they know it, they’re cycling through jails, ERs, homeless encampments and various kinds of crisis centers. With some luck, they may find themselves in the hands of competent mental health providers in a quality in-patient setting. But even in those very rare cases, they are often forced out of that care before they have the chance to stabilize and get back on their feet.

That’s due to a decades-old rule — one Colorado lawmakers are currently reconsidering — preventing mental health hospitals from being reimbursed for Medicaid patients in their care for longer than 15 days. Enacted in 1965, the rule was part of a much bigger effort intended to create community-based capacity for mental health care in the least restrictive settings and prevent unnecessary institutionalization. Today — because that dreamed-of capacity was never developed — this policy leads to the discharging of vulnerable and unstable patients from supportive in-patient settings before they have gotten all the care they need and often before they have a place to go. As a result, we’re misfiring at great cost — spending efforts and resources, over and over again across systems, fail to meet the needs of seriously ill patients.

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A recently released report from the Treatment Advocacy Center perfectly sums up the result of this worsening crisis and the disordered array of policies that perpetuate it. Colorado now has the third-longest waitlist in the country for people who are waiting in jail for access to a mental health treatment center after being found incompetent to face low-level criminal charges. Incarcerating people who are presumed innocent when they are known to have unmet health needs is an unacceptable tragedy, a violation of their rights and a disgrace to our society.

Though there are several factors in play here — over-incarceration of those with mental health needs being a glaring one — expediting Medicaid patients’ access to getting the care they need to stabilize in Colorado’s mental health hospitals is a key step we must take to disrupt this vicious cycle. Colorado lawmakers need to act now to extend Medicaid coverage for mental health care and give these vulnerable Coloradans a real shot at healthier and more productive lives. Lifting the 15-day cap on Medicaid coverage for in-patient care will enable providers to support improved health outcomes.

Research from other states that have already acted to lift the 15-day cap on Medicaid coverage for mental health treatment centers shows promising results. For one, by providing institutional care for the most acute patients, states have freed up resources for community-based services for others with lower needs. These states have also seen a decline in emergency room use after patients were more responsibly discharged from psychiatric care — saving critical health care resources. And finally, hospital readmission rates have lowered, with Vermont citing an 8% readmission rate. Hospital readmissions have been a major contributor to the capacity issues we’re facing in treatment centers: Between January 2020 and July 2023, 3,171 patients were admitted and readmitted to a Colorado mental health hospital, according to data from UHS hospitals.

If the state invests now to provide adequate mental health care to those with serious illnesses, we will diminish the hemorrhaging of resources elsewhere, including on ERs, jails, crisis response and local responses to homeless encampments. This investment will meaningfully underscore our state’s commitment to addressing this dire crisis tearing families apart and claiming countless lives. It’s time to bring our Medicaid policies into the 21st century and disrupt this deadly cycle.

Vincent Atchity is president and chief executive of Mental Health Colorado. He is an advocate for public health and health equity; has worked statewide and nationally as leader of the Equitas Project to disentangle mental health and criminal justice and promote care not cuffs, and has served on the Colorado Governor’s Behavioral Health Task Force and Behavioral Health Transformational (ARPA) Task Force.