Behavioral Health Needs are Increasing. Medicaid Programs are Trying to Keep up.

Difficulty gaining access to behavioral healthcare is nothing new, but the COVID-19 pandemic threw the imbalance between need and access even more askew. The pandemic has led to more people experiencing mental health conditions such as anxiety and depression disorders (or a combination of the two). In 2019, 11% of adults screened positive for anxiety or depression symptoms.

In April and May of 2020, during the first few months of the pandemic, that proportion tripled to about 33%, according to U.S. Census Bureau data. Barriers to access include the ability to reach and travel to providers; provider availability; social factors, such as a reluctance to get help; and, most importantly, cast.

Access to services is especially important to Medicaid enrollees, who have also experienced increased levels of behavioral health problems during the pandemic, according to a Kaiser Family Foundation (KFF) report on Medicaid expansion of behavioral health services. The foundation’s annual budget survey of state Medicaid officials showed that all the states responding to the survey reported implementing at least one behavioral health initiative to expand access during the past couple of years by, among other things, offering crisis service and expanding telehealth. “You really see so clearly that every single state that we surveyed reported at least one initiative to expand behavioral healthcare initiatives,” says Madeline Guth, a policy analyst on the KFF and author of the Medicaid behavioral health report.

Many attempts

This isn’t the first time the government has stepped in and attempted to improve access to mental health services. The 2008 Mental Health Parity and Addiction Equity Act banned payers from making mental health coverage more restrictive than physical health coverage, although there are still plenty of parity gaps. A 1996 law with the same name ensured that large group health plans could not impose less favorable lifetime or annual mental health benefit limits compared with medical/surgical benefits. The Affordable Care Act required all health plans to categorize mental health and substance abuse disorder services as essential health benefits.

Medicaid coverage is a critical piece of behavioral health coverage in the U.S. because the programs cover a disproportionate share of the people with behavioral health issues. As of July 1, 2021, Medicaid programs in 44 states and the District of Columbia covered telehealth services for mental health issues, including audio-only services, according to Guth’s report. In the past, behavioral health services have often been carved out of Medicaid managed care contracts, which, in some cases, undercut parity. Guth’s report shows that about three-quarters of the 41 states that have Medicaid managed care programs have carved in behavioral health services.

Newer government initiatives are also addressing access to behavioral health. The American Rescue Plan Act provided expanded Medicaid funding for some behavioral health providers and crisis centers, and the Build Back Better Act, if enacted, would provide additional community mental health services funding.

One way to provide better access is through care integration. Nearly half the states in the KFF survey reported integrated services initiatives whether by allowing for behavioral health and medical service payments on the same day or providing these services in the same location.“We may be seeing elevated behavior health needs for some time to come,” notes Guth. 

Deborah Abrams Kaplan writes about medical and practice management topics.