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State Medicaid Orgs Struggle to Provide Behavioral Health Services

Even though CMS opened up multiple funding avenues, state Medicaid programs are still struggling to provide for growing behavioral health needs.

CMS needs to do more so state programs can provide adult behavioral health needs.

Source: Thinkstock

By Thomas Beaton

- State Medicaid organizations may need more than flexible funding in order to provide for the growing behavioral healthcare needs of their adult populations.

In a report from the Government Accountability Office (GAO), six state Medicaid programs used multiple funding strategies to support behavioral health care, but still faced challenges when providing care for institutions for mental disease (IMDs).

The number of adults requiring behavioral health services is on the rise, requiring state Medicaid programs to find the service providers and facilities to treat them without increasing expensive ED admissions.   

“Individuals seeking care primarily for behavioral health conditions made approximately 4.7 million visits to EDs in 2013, accounting for around 3 to 4 percent of all ED visits, according to the most recently published data from the National Hospital Ambulatory Medical Care Survey (NHAMCS),” GAO explained.

Even though Medicaid is estimated to fund $71 billion in behavioral care services, the program   excludes payments for beneficiaries aged 21-64 who are residents of IMDs.

To help state programs address their unique healthcare challenges, CMS designed new funding policies that allowed states to adjust how they can allocate Medicaid spending.

These new policies included the use of 1115 waivers, Managed Medicaid Care Plans, the use of DSH payments to IMD facilities, and reducing the size of designated “facilities” to sites with 16 or fewer beds, which makes them eligible for Medicaid funds.

While several state Medicaid programs relied on a combination of 1115 demonstrations, DSH payments, or other tactics to meet their regional needs, program officials stated that there were still significant problems in behavioral care access and administration in their states.

“For instance, one state reported long waits for inpatient mental health services,” GAO said. “In addition, some facility officials said they regularly turned away patients and maintained waitlists.”

In Washington, Medicaid officials said that there is not enough capacity to meet the demand for services within the state, even though the state opened an extra 100 beds in 2014.

“Officials at two Washington facilities reported turning away patients because of a lack of available beds and patients were sometimes sent to geographically distant treatment facilities,” GAO added.

In California, Medicaid officials said that residential substance abuse services would only be available in counties that chose to participate in their Section 1115 demonstration.

“When beds are not available, an official at one California facility said that they keep a waitlist and offer the next best level of care available, typically outpatient care, until an appropriate bed becomes available,” GAO said.

In New Jersey, Medicaid administrators also said that patient access to behavioral health services is challenging in their state. “Officials said there is a problem with ED boarding in the state and there are oftentimes waitlists for substance use services,” GAO said. “Additionally, officials said it can be difficult to qualify for a bed in a substance use treatment facility.”

“To address the shortage of inpatient treatment beds, in January 2017, the governor announced plans to increase the number of beds allowed for individuals with co-occurring mental health and substance use conditions by almost 40 percent, adding 864 beds,” the agency added.

Even though state Medicaid funding options can help states improve care for vulnerable patients, the findings presented by GAO may persuade leaders at CMS take more proactive measures to ensure adult beneficiaries are receiving adequate behavioral healthcare services.


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