In the midst of escalating rates of suicide and opioid-related deaths over the past decade, alongside a national emergency regarding children’s mental health, the United States is grappling with an unprecedented mental health crisis. However, a newly released government report has shed light on the dire state of mental health care accessibility for a significant portion of Americans, particularly those covered under Medicare or Medicaid.
The report, unveiled on Wednesday by the Department of Health and Human Services’ Office of Inspector General, underscores a severe shortage of mental health care providers within the Medicare and Medicaid systems.
Examining 20 counties encompassing individuals covered by Medicaid, traditional Medicare, and Medicare Advantage plans—serving over 130 million enrollees, constituting more than 40% of the U.S. population—the report painted a concerning picture. Meridith Seife, the deputy regional inspector general and lead author of the report, emphasized the scarcity, revealing fewer than five active mental health care providers for every 1,000 enrollees. Specifically, Medicare Advantage boasts 4.7 providers per 1,000 enrollees, while traditional Medicare and Medicaid offer merely 2.9 and 3.1 providers, respectively, for the same enrollee count. Alarmingly, some counties lack even a single mental health care provider per 1,000 enrollees.
Seife pointed out the consequential challenges faced by patients in accessing care due to such limited provider availability, particularly considering the substantial need within these populations. Notably, she highlighted that one in four Medicare enrollees live with a mental illness, with less than half receiving treatment. Similarly, among Medicaid beneficiaries, one in three suffer from mental illness, and one in five grapple with substance use disorders, emphasizing the urgent demand for services.
Deborah Steinberg, senior health policy attorney at the nonprofit Legal Action Center, commented on the report, expressing that while the findings are unsettling, they align with the historical underrepresentation of mental health and substance use disorder care within Medicare and Medicaid.
Furthermore, the report revealed the logistical challenges endured by individuals who manage to secure appointments with providers, with a significant portion having to travel long distances for care. Seife highlighted that a quarter of patients traveled over an hour, while one in ten traveled over an hour and a half each way for their appointments, with some enduring two-hour journeys for mental health care.
Heather Saunders, a senior research manager at KFF’s Medicaid team, emphasized the widespread shortages in the behavioral health workforce, affecting all payer systems and populations. However, the report highlighted a particular issue with Medicare and Medicaid, indicating that only about a third of mental health care providers in the counties studied serve Medicare and Medicaid patients.
The report attributed this disparity to lower reimbursement rates and a high administrative burden, deterring many providers from participating in Medicare and Medicaid. Steinberg elaborated on the reimbursement discrepancies, indicating that certain providers receive only 75% of the physician fee rate set by Medicare, exacerbating the challenges in provider participation.
In summary, while the mental health crisis in the United States continues to escalate, the report underscores the urgent need for reforms within Medicare and Medicaid to address the glaring gaps in mental health care accessibility for vulnerable populations.
