Using Medicaid to Support Working Age Adults with Serious Mental Illnesses in the Community: A Handbook. Endnotes


  1. Remarks by President Bush on April 29, 2002 in Albuquerque New Mexico announcing the formation of the New Freedom Commission on Mental Health.

  2. World Health Organization (2001). The World Health Report 2001 -- Mental Health: New Understanding, New Hope. Geneva: World Health Organization.

  3. As defined by Section 1912(c) of the Public Health Services Act (as amended by P.L. 102-321), an adult with a serious mental illness is:

    “a person age 18 and over, who currently has, or at any time during the past year has had a diagnosable mental, behavioral, or emotional disorder of sufficient duration to meet diagnostic criteria specified within the DSM III-R (Diagnostic and Statistical Manual for Mental Disorders), and that has resulted in functional\ impairment that substantially interferes with or limits one or more major life activities.

    “Functional impairment is defined as difficulties that substantially interfere with or limit role functioning in one or more major life activities including basic daily living skills (e.g., eating, bathing, dressing); instrumental living skills (e.g., maintaining a household, managing money, getting around the community, taking prescribed medication); and functioning in social, family, and vocational/educational contexts. Adults who would have met functional impairment criteria during the referenced year without benefit of treatment or other support services are considered to have serious mental illnesses.”

  4. United States Public Health Service, Office of the Surgeon General (1999). Mental health: A Report of the Surgeon General. Rockville, MD: Department of Health and Human Services, U.S. Public Health Service.

  5. The estimated annual economic cost of mental illness is $79 billion, including loss of productivity. President’s New Freedom Commission on Mental Health (2003). Achieving the Promise: Transforming Mental Health Care in America. Final Report. Rockville, MD: Department of Health and Human Services Publication No. SMA-03-3832. [Hereafter, PNFCMH (2003)]

  6. Ibid.

  7. Steven J. Onken, Ph. D. and Jeanne M. Dumont, Ph.D. (2002). Mental Health Recovery: What Helps and What Hinders? Alexandria VA: National Association of State Mental Health Program Directors and the National Technical Assistance Center for State Mental Health Planning.

  8. Coffey, R.M., Mark, T., E., Harwood, H., McKusick, D., Genuardi, J. et al. (2000). National Expenditure Estimates of Expenditures for Mental Health and Substance Abuse Treatment, 1997. Rockville, MD: Substance Abuse and Mental Health Services Administration. (SAMSHA Publication SMA-00-3499)

  9. Ibid.

  10. Jeffrey A. Buck (2003). Medicaid, Health Care Financing Trends, and the Future of State-Based Public Mental Health Services. Psychiatric Services, Vol. 54, No. 7. In 1997, Medicaid accounted for about one-half of state and locally administered mental health spending. This share is forecast to increase to about two-thirds of spending by 2017.

  11. For example, in Florida it is estimated that Medicaid accounts for 62 percent of spending (Celeste Putnam, Florida Director of Mental Health: personal communication, June 2003.) In California, the figure is even higher -- 68 percent. California Mental Health Planning Council (2003). California Mental Health Master Plan: A Vision for California. Sacramento: MHPC. Available on the Internet at:

  12. President's New Freedom Commission on Mental Health. (2002) Interim Report of the New Freedom Commission on Mental Health. Rockville MD.

  13. PNFCMH (2003).

  14. Available at:

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