Although 90% of American believe that the country is in a mental health crisis, treatment rates across all payors are low. Workforce challenges impact access to mental health care for almost half of US citizens. One hundred fifty-eight million people, or 47%, live in a mental health shortage area. Behavioral health issues are most prevalent in Medicaid enrollees, with Kaiser Family Foundation (KFF) data from 2020 indicating that approximately 39% of Medicaid enrollees experience mental health or substance use disorders. Workforce shortages exist everywhere in mental health, but they are particularly acute in Medicaid populations. Medicaid telehealth is positioned to provide solutions. Before looking at Medicaid for telehealth, reviewing these data from a new KFF study may be helpful.
- Only 36% of psychiatrists accept new Medicaid patients, whereas overall, physicians accept Medicaid for other disorders at the rate of 71%
- Providers who accept Medicaid appear only to serve a few patients or
- Have lapses where they do not accept new Medicaid patients at all.
This workforce shortage issue has drawn attention at the federal and state levels to address these issues for Medicaid enrollees. The December 2022 Consolidated Appropriations Act addressed workforce shortages in some areas that may help, including the following:
- New psychiatry residency openings
- Reduction of requirements for opioid use disorder (OUD) providers to prescribe medications
- Improved Medicaid provider directories
- New funds for peer support provider workforce initiatives.
To clarify the workforce issue, KFF surveyed state Medicaid officials about their strategies to address the behavioral health workforce shortages for FY 2022 and FY 2023. Below are some of the findings of KFF’s Behavioral Health Survey of state Medicaid programs. Forty-four states responded to the survey.
Overall, state strategies fall into these four key areas:
- Increasing reimbursement rates
- Reducing provider administrative burden
- Extending the workforce by approving additional providers to attract and retain behavioral health providers
- Incentivizing participation, for example, by implementing prompt payment policies.
Readers seeking details of all four areas are encouraged to see the original report.
Role of Medicaid Telehealth at the State Level
In another KFF study, states have broad authority to cover telehealth in Medicaid without federal approval. Telehealth utilization trends show that behavioral health remains a top category of services with high utilization rates, with more than three-quarters of states reporting that behavioral health services were among those with the highest utilization in 2022. In the current survey, the state of Nebraska responded that telehealth was the most effective strategy for addressing its behavioral health workforce challenges.
Other population trends in FY 2022 or anticipated for FY 2023 showed varying telehealth utilization by:
- Geography (urban vs. rural dwellers). Consistent with Government Accountability Office (GAO) research, telehealth utilization during the pandemic was lower for some rural Medicaid enrollees than for urban Medicaid enrollees. As expected, rural enrollees may need help with adequate or unaffordable broadband access. Some states reported the opposite, with rural dwellers having three states with higher utilization of telehealth.
- Race and gender. While only five states reported telehealth utilization trends by race/ethnicity, all reported that utilization was higher among White enrollees than Medicaid enrollees of color. Similarly, of the six states that shared trends by gender, they all indicated that telehealth utilization was higher among female versus male enrollees.
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IMAGE: States Providing Medicaid Coverage of Behavioral Health Services Delivered via Audio-Only Telehealth, as of 7/1/2022, KFF, accessed 1/30/23, https://www.kff.org/medicaid/issue-brief/telehealth-delivery-of-behavioral-health-care-in-medicaid-findings-from-a-survey-of-state-medicaid-programs/
Optimizing Telehealth Billing: Current Telehealth CPT Codes & Telehealth Reimbursement Strategies
Today’s telehealth CPT codes and other telehealth billing issues are in rapid flux. Information gathered from online searches or colleagues can be outdated and incorrect — and lead to frustrating claim denials.