By Surabhi Dangi-Garimella, Ph.D.
Perhaps a cliched statement, but the COVID-19 pandemic has had a significant psychological impact on a large portion of the global population and has renewed stakeholder interest in providing access to behavioral health services for those who need them. Pandemic or not, mental health struggles are real and can vary in scale. The bottom line is for individuals to be able to receive the care and support they need so they can continue to lead a normal life.
Here are some hard statistics shared by the National Alliance on Mental Illness (NAMI):
- 20% of U.S. adults experience mental health issues annually
- 16% of children between 6-17 years old experience mental health issues annually
- 50-75% of all lifetime mental illnesses begin between the ages of 14 and 24 years
- For those between 10-34 years old, suicide is the second leading cause of death
- 46.2% of U.S. adults and 50.6% of children between 6-17 years old received treatment for their mental health issues in 2020
NAMI has also developed state-level fact sheets that provide state-specific statistics.
Access Remains an Issue
Speaking with Patients Rising Now, Nishi Rawat, MD, co-founder of OpenBeds and Senior Vice President at Appriss Health, explained that nearly half of the telehealth services utilized during the pandemic were used to address mental health issues. She pointed out, however, that lack of access to technology and the cost of telehealth services can prevent individuals from underserved and low-income communities from getting necessary care.
Those residing in rural areas often face healthcare access challenges due to a lack of treatment facilities or simply a lack of experts in their region—access to mental health specialists is no different. Earlier this year, the government announced that $13 million will be directed toward improving access to behavioral health services in rural America, including treatment for substance-use disorders.
What About Health Insurance Coverage?
Mental health and substance abuse services are an essential health benefit, which means health plans are required to cover these services, although benefits may vary depending on the state requirements. All Marketplace plans are required to cover:
- Behavioral health treatment, such as psychotherapy and counseling
- Mental and behavioral health inpatient services
- Substance use disorder treatment
Health plans cannot deny coverage or charge more if someone has mental health issues as a pre-existing condition. Additionally, plans are forbidden from placing yearly or lifetime dollar limits for mental health coverage. These services are expected to be in parity with medical and surgical benefits.
Medicaid coverage for behavioral health services may fall under the following authorities and may vary in the services offered and which enrollee can avail of those services:
- State plans
- Medicaid waivers
- Other authorities for Medicaid payment
- Section 1115 demonstration
- Alternate benefit plans (ABPs)
- Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit
- Demonstrations for dual eligible
While this introduces significant variance in coverage of behavioral health services between states and even within a state, states are mandated to provide specific services to certain groups:
- Children enrolled in Medicaid are entitled to receive mental health services under the EPSDT benefit in all states
- For newly eligible beneficiaries, ABPs have to provide behavioral health services as an essential health benefit and at parity with medical and surgical benefits. However, if paid under fee-for-service, essential benefits and parity laws do not apply.
A recent Kaiser Family Foundation survey of state Medicaid Directors found that all 50 states had at least one initiative to expand behavioral healthcare within Medicaid. The survey also found that:
- >50% of states plan to adopt a community-based mobile crisis intervention service option (under American Rescue Plan Act) and >33% are planning for another crisis service initiative.
- Many states plan to continue offering expanded telehealth services for behavioral health that were initiated during the COVID-19 pandemic.
- Managed care organizations provide behavioral health services on behalf of most states.
While states plan to maintain or expand these services, funding pressures and post-pandemic changes may demand alternate approaches.
Surabhi Dangi-Garimella, Ph.D. is a biologist with academic research experience, who brings her skills and knowledge to the health care communications world. She provides writing and strategic support to non-profit groups via her consultancy, SDG AdvoHealth, LLC.
