National Council for Behavioral Health

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Medicaid, the public health insurance program for low-income populations, is a vital funder of both mental health and addiction services in the United States. It is currently the largest source of funding for America’s public mental health system and Medicaid continues to make up a growing share of the total spending on addiction treatment.

Medicaid coverage provides enrollees a broad range of services at low or no cost. Examples of Medicaid-covered behavioral health services include: psychiatric hospital visits, case management, day treatment, psychosocial rehabilitation, psychiatric evaluation, psychiatric testing, medication management, individual therapy, group therapy, family therapy, inpatient detoxification, methadone maintenance, and smoking and tobacco cessation services. While Medicaid benefits vary state to state, Medicaid coverage generally offers a more comprehensive array of behavioral health services than other insurers.

Importantly, Medicaid also provides coverage for primary care services. On average, individuals with behavioral health disorders experience a higher rate of chronic physical health conditions than the general population. Medicaid helps individuals manage not only their behavioral health needs, but any co-occurring physical disorders such as high blood pressure, diabetes, obesity, etc.

Medicaid Access at Risk Under Some Current Regulatory Proposals

In June 2020, the Centers for Medicare and Medicaid Services (CMS) proposed a new regulation on the Medicaid program that would significantly expand the definition of “line extension.” This new definition greatly expands the scope of drugs potentially subject to government-imposed rebate penalties.

This regulation has the potential to harm patients with chronic conditions by reducing their ability to receive combination medications as well as future health care innovations.

Combination medications are the antidote to an otherwise confusing cocktail of pills and prescriptions. With one dose, they do the work of multiple medicines‚ improving adherence to treatment for mental health disorders, HIV, hepatitis, and other chronic conditions, yielding better health outcomes.

For millions living with serious mental health conditions, non-adherence to treatments is common and increases risk of relapse and hospitalization. Innovations such as combination medications are evolving to better meet the needs of patients, showing enormous progress in helping patients take their medicines consistently, which plays a profound role in successful management of mental health conditions, and reducing negative and health-threatening outcomes that occur when medicines are not taken as prescribed.

For patients living with HIV, hepatitis, or other chronic viral conditions, combination medications have shown to improve adherence to needed drug regimens, result in better outcomes and reduced transmission, and save on overall health care costs.

And yet for as much good as they do, if finalized, CMS’ proposal would disincentivize future development of these kinds of medicines at a time when patients are looking for cures and treatments.

How You Can Protect Medicaid & Access to Medication

With COVID-19 impacting our communities and health care systems, there has never been a more important time to speak up for behavioral health and turn your inspiration into action.

It is easy to get involved, here are things you can do today:

  • Contact CMS NOW at (202) 619-0630 to oppose finalization of the overly broad definition of line extensions that could hurt medical innovation for patients.
  • Visit the National Council’s Policy Agenda page. Each week, the National Council will have a Call to Action for advocates to educate lawmakers on why preserving and protecting Medicaid is critically important to our community.
  • Sign up to be a National Council Ambassador. Our superstar advocates devote extra time each year building relationships with their Members of Congress so that when votes come to the wire, they can help tip the scales. Contact Michael Petruzzelli to learn more.

Medicaid Expansion

The Affordable Care Act provided states the option to expand Medicaid to 138% of the federal poverty level. So far, 26 states and the District of Columbia have expanded Medicaid, adding more than 7.2 million people to the Medicaid rolls. According to Substance Abuse and Mental Health Services Administration estimates, these reforms have increased access to health care for about 3 million low-income individuals living with mental health and substance use conditions. In the 24 states that have not opted to expand Medicaid, an estimated 4 million people who have a mental health or substance use disorder would be eligible for coverage.

National Council Medicaid Fact Sheets

Learn more about the importance of Medicaid for opioid treatment and the potential impact the elimination of it would have with these fact sheets.

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State Fact Sheets on Medicaid and Mental Health/Addiction Services

View state-specific information.

 

Download our Advocacy Handbook

Medicaid Expansion Resources<

Position Statements

Health & Economic Benefits

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Shareables for Social Media

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Excellence in Mental Health Act

Signed into law in March, 2014, the Excellence Act established a federal definition and criteria for “Certified Community Behavioral Health Clinics” or CCBHCs. It also provided for a 2-year, 8 state Medicaid demonstration program for CCBHCs to receive an enhanced payment rate. For more details, visit our Excellence Act website.

Medicaid Health IT Incentive Payments

The American Reinvestment and Recovery Act of 2009 created a $19 billion health information technology program which provides federal incentive payments for the adoption and meaningful use of health IT in medical practice. Unfortunately, behavioral health facilities and many behavioral health providers are not eligible to receive these incentive payments. The National Council supports legislation to include mental health and substance abuse providers in the Health IT incentive program. For more information, please visit our Behavioral Health IT page.

IMD Exclusion

The “Institutes for Mental Disorders” (IMD) exclusion imposes a federal payment prohibition on Medicaid services provided to patients who are residents of such institutions. Originally intended to prevent states from warehousing individuals with mental illness in institutions, the payment exclusion has posed a challenge for some residential mental health and substance use treatment centers. The Breaking Addiction Act of 2014 (H.R. 5136) would improve Americans’ access to substance use treatment by scaling back the federal payment exclusion for certain community-based substance use facilities.

PROMOTING EFFECTIVE IDENTIFICATION OF MEDICALLY FRAIL INDIVIDUALS UNDER MEDICAID EXPANSION

The National Council and Community Catalyst offer recommendations on effective design and implementation of a screening and benefits determination approach for medically frail individuals, based on the experience of early-adopter states such as Arkansas and Iowa. This guidance focuses on defining this population and ensuring that their access to coverage is best suited to the unique and comprehensive health needs of persons with
mental health and substance abuse disorders.

Dual Eligible Enrollees

Dual eligibility applies to a portion of the population that is eligible for both Medicare and Medicaid. The approximately 9.6 million Medicare-Medicaid enrollees (MMEs) are among the most vulnerable and highest cost enrollees in the Medicaid and Medicare systems. Approximately twenty percent of those dually enrolled show evidence of one or more mental illness.

The Center for Medicare and Medicaid Services and States are seeking financial and administrative alignment of services for dually eligible Medicare-Medicaid enrollees. Fifteen states are moving forward, and 11 of them have chosen a capitated managed care approach. Be sure to check out the National Council’s Ensuring Access to Behavioral Healthcare through Integrated Managed Care: Options and Requirements paper for more information on dual eligible enrollees.

Medicaid Home- and Community-based Services Waivers

The Medicaid home and community-based services (HCBS) waiver provides opportunities for Medicaid beneficiaries to receive services in their own home or community. Currently, 47 states and the District of Columbia use these waivers to provide services to various groups, such as: the aged and disabled; individuals with mental health disorders; children: and individuals with HIV/AIDS.

In January 2014, the Centers for Medicare and Medicaid Services issued released a final rule that expands Medicaid payments for home- and community-based services and gives states more flexibility in administering their waiver programs. The final rule also gives states some flexibility in how they pay for home- and community-based care. States will have a transition period of one year to put these changes into effect.

Permanent Supportive Housing

Using Medicaid to Finance and Deliver Services in Supportive Housing: Challenges and Opportunities for Community Behavioral Health Organizations and Behavioral Authorities: Authored by the Technical Assistance Collaborative

Accountable Care Organizations (ACOs) and Medicaid

Today, an increasing number of Accountable Care Organization (ACOs) are responsible for delivering comprehensive, coordinated care to patients in a way that brings down overall health care costs. Without careful attention to behavioral health by ACOs, behavioral health conditions, such as depression or anxiety, will continue to be key contributors to chronic diseases and hospitalizations. Moving forward, ACOs will need to integrate behavioral health care in order to achieve specific quality and cost-savings targets. For this reason, the National Council has created this guide to help community providers, states, and advocates understand the ACO model and how it can be used to best meet the needs of children and adults with behavioral health disorders. It draws upon what has been learned about Medicaid ACOs and makes recommendations about how states can ensure that their Medicaid health system addresses the behavioral health needs of all their members.

IN THE NEWS:

Visit our Capitol Connector blog to read the most recent news about Medicaid.