Healthcare / Medicaid / Politics

Demand Greater than Supply; Medicaid Expansion of Mental Health Services

The Affordable Care Act is attempting to bridge the health disparity gap in mental health services of millions of people who were previously uninsured or whose policies did not include mental health coverage before. However, as millions of Americans now gain health coverage through the Affordable Care Act’s Medicaid expansion, the reality of the difficulties and lack of resources to treat the high volume of patients is coming out of the woodwork.

In the newly expanded Medicaid states, more than 1.2 million uninsured adults newly eligible for coverage have some sort of mental illness. An estimated 550,000 of those have serious mental disorders that impede everyday life. These high rates of mental health disorders mean an influx of patients in a field that already suffers an extreme lack of counselors and behavioral therapists who accept Medicaid patients.

Many mental health specialists in private practice do not accept Medicaid, which pays on average about 66 percent of what Medicare does. Besides Medicaid’s low reimbursement rates, many therapists are also dissuaded by the copious paperwork that takes too much time and the challenging casework of Medicaid patients.

On top of this, now that the new health law has made mental health treatment a mandatory benefit for millions of people with private coverage, the demand for mental health specialists is going to exponentially increase. This increase of demand means it will be even harder for Medicaid’s community-based providers to recruit and retain mental health specialists. The increased competition of an already limited supply of specialists means prices are going to heighten; a conundrum of supply and demand.

As a result of the aforementioned barriers to access, those who are covered under the Medicaid expansion will be treated at community mental health agencies and health centers that serve low-income patients. However as the new expansion population floods the gates of these facilities, the dam will break due to present staff shortages and a logjam of patients waiting for care will continue to pile up.

Kentucky is already suffering the shortfalls of the new Medicaid expansion on mental health services. In Louisville, with a population of 600,000, most new Medicaid enrollees are filtering in to four adult mental health clinics run by Seven Counties, who declared bankruptcy last year. In Louisville, therapists are booked more than six weeks out and caseloads have more than doubled in the past year. Given these long waits for individual therapy sessions, Seven Counties is trying group therapy. Other systems are following suit and combating the mental health staff shortage by having “peer support” counseling. Instructors, who are recovering from their own health struggles, lead peer support counseling.

While this one solution may temporarily fix the problem of access to care, it brings up another question of quality of care. Is it acceptable to compromise quality of care for access to care in the nation’s most vulnerable population? For right now it remains a Catch-22. The unfortunate reality for right now is that health systems need to try and make do with very limited resources until a workable solution to access and quality of care of mental health services becomes readily available.