[NYAPRS Enews] MHW: Medicaid Expansion Reduces Unmet Need For MH Treatment

[Thomas Templeton]

NYAPRS Note: Later this year, Louisiana will become the 31st state to expand Medicaid under the Affordable Care Act. According to a new Issue Brief from the Office of the Assistant Secretary for Planning and Evaluation (ASPE), if all states expanded Medicaid, more than 370,000 fewer people would experience depression and more than half a million would report being in good or excellent health.
The report, "Benefits of Medicaid Expansion for Behavioral Health" details compelling reasons why all states should expand, including the fact that treatment rates are lower for those with behavioral health conditions in states that have not. It also suggests that other medical costs, including unnecessary hospitalizations, will be reduced, and that criminal justice costs may go down as well.
NYAPRS believes that Medicaid expansion must be a central aim among those who are serious about improving mental health care across the U.S. While we - and others - have known this for awhile, the ASPE report confirms it.

Medicaid Expansion Reduces Unmet Need For MH Treatment
Mental Health Weekly April 4, 2016

To date, 30 states plus the District of Columbia have expanded Medicaid under the Affordable Care Act (ACA). If the states that have yet to expand Medicaid do not change course, more than 4 million of their citizens will be deprived of health insurance coverage in 2016, according to a new Issue Brief released March 28 by the Office of The Assistant Secretary for Planning and Evaluation (ASPE).

On July 1, Louisiana will become the 31st state to expand its Medicaid program.

Nearly 30 percent of people with behavioral health needs made up a substantial share of all low-income uninsured individuals living in states that have not yet expanded Medicaid, according to the report.

If all states expanded Medicaid, an estimated 371,000 fewer people each year would experience depression, and 540,000 more people would report being in good or excellent health, according to the ASPE report.

Obama's FY 2017 federal budget includes a legislative proposal to provide any state that expands Medicaid with the same three years of full federal funding and same phasedown as the states that expanded the program in 2014, according to Office of Management and Budget Director Shaun Donovan and Domestic Policy Council Director Cecilia Muñoz. This would be the case no matter when the state expands the program, they said.

The report, "Benefits of Medicaid Expansion for Behavioral Health," notes that an estimated 1.9 million uninsured people with a mental illness or substance use disorder that have incomes that could qualify them for coverage live in the states without Medicaid expansion. The report found that while some of these individuals had access to some source of health insurance in 2014, many will gain access to coverage only if their states expand Medicaid, and others would gain access to more affordable coverage.

Beyond the health benefits, those gaining coverage experience greater financial security, and state economies benefit from higher standards of living through the infusion of federal funds, greater macroeconomic resilience and healthier and more productive workers, the report stated.

Lower treatment rates
ASPE officials say unsurprisingly, the uninsured also had lower treatment rates than the insured. While 16.4 percent of individuals 18-64 that were insured in non-expansion states received treatment for mental illness or a substance use disorder, among the uninsured in this age category, only 11.5 percent received treatment despite the fact that the uninsured had higher rates of substance use disorder and mental illness.

Research has consistently found that there are substantial delays from the time a first episode of serious mental illness occurs and when people receive treatment for this condition, according to the report. In the case of schizophrenia, this delay can worsen outcomes, while early comprehensive treatment can improve prognosis and is cost-effective.

In 2014, among the 43.6 million adults with a mental illness, 55 percent did not receive mental health services in the past year; 31.5 percent of the 9.8 million adults with serious mental illness did not receive mental health services; and among the 21.5 million individuals who met criteria for a substance use disorder, only 11 percent received treatment.

Among low-income adults, Medicaid expansion is associated with a reduction in the unmet need for mental health and substance use disorder treatment. Adjusting for differences in state programs, researchers found that among low-income individuals with a serious mental illness, the likelihood of mental health treatment was 30 percent greater for individuals enrolled in Medicaid.

Medical costs reduction
In addition to allowing individuals access to treatment, coverage expansion may reduce other medical costs, increase employment productivity and lower overall rates of depression, researchers stated. In some instances, individuals will be able to receive Medicaid-covered treatment in place of state general revenue-funded treatment, possibly allowing for improvements in behavioral health programs at no new additional cost to the state, according to the report.

An influx of new funds may allow for screening and prevention programs that may better meet the behavioral health needs of state populations and further improve behavioral health programs, the report stated. There is also compelling evidence of numerous other benefits associated with treatment of behavioral health disorders, such as reduced criminal justice costs.

Medicaid expansion also offers states the opportunity to cover a significant proportion of individuals experiencing homelessness, many of whom have significant behavioral health conditions. Reducing homelessness improves community stability and reduces state costs across multiple service systems, the report stated. Even in states that have expanded coverage, individuals experiencing homelessness are more likely to continue to have frequent emergency department visits, with
homeless individuals with co-occurring mental illness and substance use disorders at greatest risk for hospitalization.

Denying coverage
"It is a crime that we still have 20 states denying health insurance coverage to eligible residents with behavioral health conditions by refusing to participate in the ACA's Medicaid expansion program," Joel E. Miller, executive director and CEO of the American Mental Health Counselors Association, told MHW.

"Many of these citizens have serious mental illnesses such as bipolar disorders and are not receiving needed treatments because they cannot afford to pay for those services."

Miller added, "All the 20 non- Medicaid expansion states are really doing is transferring all the expenses of uninsured and untreated individuals with serious behavioral health conditions to emergency departments, inpatient hospital units, jails and prisons, homeless shelters and schools, and adding to our suicide rates."

The Medicaid expansion program, said Miller, serves as a "life-changing" initiative for millions of people with behavioral health conditions in the 30 states that have opted in. "It's too bad the other 20 states and the two million people with behavioral health conditions who reside in those communities are unable to get needed care to help them rebuild their lives," he said.

Lack of access to covered services will result in more people with a mental illness developing a crisis condition, said Miller. "The health and lives of these individuals are on the line and in the hands of those state officials," he said.

Miller noted President Obama's announcement on March 29 that he would support new measures for expanding addiction treatment, especially in light of the growing epidemic of opioid overdoses and heroin deaths. The ACA's Medicaid expansion program would play a major role in fighting substance use disorders if the states that are currently not participating in the initiative opted in, he said.

"Participating in the Medicaid expansion would free up billions of dollars for needed treatments to help people who are suffering with addiction disorders like opioid overuse," Miller said.
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