Reform Medicaid to close gap in behavioral health care access

The exponential expansion of telehealth in the last year, fueled by the necessity to limit unnecessary social interaction, has been well documented. For example, one health plan’s utilization of telehealth increased from about 100 virtual visits a week to more than 4,000 per week in April and May of 2020: many of these telehealth visits addressed behavioral health issues. 

We overlook that the primary driver of telehealth expansion has been to meet mental health treatment needs. In fact, an estimated one in three telehealth encounters during the pandemic have addressed behavioral health issues—including substance use—within the commercial market, compared to two in three in the Medicaid market. The last 10 months have highlighted that many Michiganders’ behavioral health needs went unmet prior to the COVID-19 pandemic. The gap in access to high quality, affordable behavioral health care for those enrolled in Medicaid has never been so apparent.

Opportunities for improvement are born out of crisis, and the Medicaid program in Michigan is in the midst of a behavioral health access crisis. Our system treats the physical and behavioral health needs of the Medicaid population as if they are unrelated. This siloed approach is a relic from a time when mental health was commonly viewed as unequal, or even unrelated, to physical well-being. Policy makers in Lansing need to take immediate action to fix our bifurcated, broken and wasteful system. 

Policy makers should immediately address this behavioral health access crisis by reforming the Medicaid program. The model to follow is the one used by millions of Michiganders who receive their health insurance benefits from employers or purchase them on the federal Health Insurance Marketplace. Fully integrate the financial, operational and clinical structures of the Medicaid program under one resource—the enrollee’s health plan.

Studies have shown that health care spending can increase up to 75 percent when beneficiaries with a chronic physical condition also have a mental illness. Nationally, Medicaid beneficiaries with a behavioral health diagnosis account for almost half of total Medicaid expenditures.

States like Arizona and Washington have already integrated physical and behavioral health benefits under accountable managed care organizations and they have achieved amazing results—improving all measures of ambulatory care, preventive care and chronic disease management, while also achieving improvements in beneficiary satisfaction scores. This means a financially, operationally and clinically integrated Medicaid program has been proven to improve the overall health of the population it serves, reduce the cost to taxpayers of providing those services, and improve patient satisfaction.

Michigan is ripe for reinventing our behavioral health system to serve our enrollees and the model is clear. The data clearly speaks to a need and behavioral health should not be a partisan issue. In this era of hyper-partisan hyperbole, reforming Medicaid to treat the whole person would be a victory for Democrats, Republicans, taxpayers and, most importantly, beneficiaries who deserve better care.