Mikkel William/Getty Images
Mikkel William/Getty Images
The United States is facing an unprecedented mental health crisis, with suicide rates and opioid death rates rising over the past decade, and children's mental health being declared a national emergency. But a new government report released Wednesday shows that access to mental health care remains extremely limited for the majority of Americans, including the most vulnerable.
A report from the Department of Health and Human Services' Office of Inspector General found that Medicare and Medicaid have a severe shortage of mental health providers.
The report examines 20 counties with people using Medicaid, traditional Medicare, and Medicare Advantage plans, which together account for more than 130 million enrollees (US population (more than 40% of the population), said Meridith Saif, deputy regional inspector general and lead author of the book. Report.
Medicaid targets low-income people, and Medicare primarily targets people over 65 and younger people with chronic disabilities.
The report found that there are fewer than five active mental health care providers per 1,000 enrollees. On average, Medicare Advantage has 4.7 providers per 1,000 enrollees, while traditional Medicare has 2.9 providers and Medicaid has 3.1 providers for the same number of enrollees. I have a provider. The situation is even worse in some counties, where there are no providers for every 1,000 people enrolled.
“When there are so few providers who can see so many enrollees, patients begin to experience significant problems finding treatment,” Seife says.
The findings are particularly concerning given the level of need for mental health care in this population, she says.
“In Medicare, one in four people on Medicare has a mental illness,” she says. “However, less than half are receiving treatment.”
Among Medicaid recipients, one in three has a mental illness and one in five has a substance use disorder. “So the need is huge.”
Deborah Steinberg, a senior health policy attorney at the nonprofit Legal Action Center, said the results are “scary” but “not all that surprising.” She said, “People on Medicare and Medicaid are often underserved, and this is especially true when it comes to mental health and substance use disorder care.”
According to the report, many people who are able to find and connect with a provider meet with one several times a year. And many people have to drive long distances to appointments.
“Approximately one in four patients had to travel more than an hour to their appointment, and one in 10 had to travel more than an hour and a half each way,” Seife said. He said some patients traveled two hours each way for mental health care.
Mental illness and substance use disorders are chronic illnesses that require ongoing care, Steinberg said. “And when he has to travel an hour, or more than an hour, for appointments throughout the year, it becomes unreasonable. It becomes intolerable.”
“We know that behavioral health workforce shortages are widespread,” said Heather Sanders, senior research manager on KFF’s Medicaid team. “This affects all payers and all populations, with about half of the U.S. population experiencing a labor shortage.”
But as the report reveals, the story of Medicare and Medicaid is much more than that. Only about one-third of mental health providers in the counties surveyed see Medicare and Medicaid patients. This means that the majority of employees do not participate in these programs.
This is well documented in Medicaid, Sanders points out. “Only a small percentage” of providers on the provider directory see Medicaid patients, she said. “And when we do see Medicaid patients, we often only see a few.”
Low reimbursement rates and high administrative burdens are preventing more providers from participating in Medicaid and Medicare, the report said.
“The Medicare program sets physician fee rates,” Steinberg explains. “Certain health care providers, such as clinical social workers, mental health counselors, and marriage and family therapists, will be reimbursed at 75% of that rate.”
Medicaid reimbursement for psychiatric services is even lower than Medicare, said Ellen Weber, senior vice president of health initiatives at the Legal Action Center.
“They include these discriminatory criteria in setting interest rates,” Steinberg said.
A new report recommends that the Centers for Medicare and Medicaid Services (CMS) take steps to increase payments to health care providers and reduce administrative requirements. CMS said in a statement that it has responded to those recommendations in the report.
According to research by KFF's Sanders and colleagues, many states have already begun to take action on these fronts to improve Medicaid participation.
Some have increased payments to mental health providers. “However, the size of those increases varied widely by state. Some states limited the increases to one provider type or one type of service, while others were more widespread across the board.” There have been significant price increases,” Sanders said.
Some states are also trying to simplify and streamline paperwork, she added. “It's less complex and easier to understand,” Saunders says.
However, it is too early to know whether these efforts have had a significant impact on improving access to providers.
Steinberg said CMS is taking steps to address the provider shortage.
“CMS tried to raise some of the reimbursement rates without really solving that structural problem,” Steinberg said. “We're trying to add a little bit here and there, but it's not enough, especially when you're only adding 1 percent to the overall bill. It's really a small increase.”
The agency has also begun covering treatments and health care providers that it did not previously cover.
“In 2020, Medicare started covering opioid treatment programs, which is where many people can go to get medication for substance use disorder,” Steinberg says.
She added that starting this year, Medicare will also cover “mental health counselors, including addiction counselors and marriage and family therapists.”
While noteworthy and important, Steinberg says more needs to be done. “For example, in the field of substance use disorders, many addiction counselors do not have a master's degree, and that is now one of the requirements to become a counselor in the Medicare program.”
Removing these stringent requirements and adding other types of providers, such as peer support specialists, is key to improving access. And the cost of not getting care is high, she added.
“For the past 20 years, [in] As the elderly population grows, the number of overdose deaths has increased by a factor of 4, or 4,” Steinberg said. causing fatal accidents. It's causing people to go to the hospital.will increase [health care] It costs money. ”
