Sara Rosenbaum, JD Leighton Ku, PhD, MPH Thanks to the RCHN - - PowerPoint PPT Presentation

Emily Jones, PhD, MPP Julia Zur, PhD, MPH Sara Rosenbaum, JD Leighton Ku, PhD, MPH

Thanks to the RCHN Community Heath Foundation

• Increasing access to insurance helps bolster the care

delivery infrastructure

• This paper estimates the impact of state failures to

expand Medicaid on capacity for specialist BH services in health centers

– As of June 2014, 24 states has failed to expand

• These findings highlight the negative consequences
• f rolling back gains in insurance

Overview

• CEA estimated $66 billion in economic activity through

2017 foregone by states that failed to expand

• Evidence of inadequate MH/SUD treatment capacity

– Workforce shortages – Unmet need and reasons for not accessing treatment – Waitlists – ED visits, hospitalizations – Rise in homelessness, need for MH/SUD services in CJ settings – Overdoses

• Increased availability of MH/SUD services in primary

care settings

Introduction

• Federally-qualified health centers are an important

source of BH capacity

– Underserved areas – Homeless, CJ, schools

• On-site BH capacity in health centers is not required

– Found to be sensitive to grant funding

• On-site MH/SUD capacity in FQHCs is important

– FQHCs report problems referring patients to offsite specialist services – Can improve treatment initiation and engagement

Background

Recent investments in BH capacity in health centers

• Grant funding
• Medicaid
• Technical assistance and project ECHO-style

behavioral health consultation model using telehealth

• PCMH recognition

Background

Methods

FQHC Caseloads and Insurance Mix Total FQHC Revenues = Costs Number of MH/SUD Encounters

• Change in FQHC caseloads

– Change in insurance mix

• FQHC revenues

– Increase in revenues or reduction in losses

• FQHC spending

– Health center revenue funds the costs of service provision – Percentage of costs for MH/SUD specialist staffing and

• verhead:
• 4.9% for MH
• 0.7% for SUD
• Number of encounters with MH/SUD specialists

Methods

• Health centers in states that failed to expand

Medicaid by 2014:

– Located in the South – Rural: 58% versus 39% in expansion states – Smaller: 14k versus 21k patients per year – Less likely to be PCMH-recognized: 29% versus 37% – Caseloads skew slightly older

• Caseloads in states that expand Medicaid:

– Medicaid: increases from 37.1% to 47.1% – Uninsured: declines from 29.2% to 21.5%

Findings

• If all states expand Medicaid by 2020, $230 million in

additional revenue could accrue to health centers

• $12.9 million would fund services provided by

MH/SUD specialists

– $11.3 million for MH services – $1.6 million for SUD services

• Over 70,000 additional encounters

– Over 59,000 with MH specialists – Over 11,000 with SUD specialists

Findings

• Investments in insurance expansion bolster the care

delivery infrastructure

– When individuals gain insurance, MH/SUD providers gain revenue

• This additional revenue can bolster capacity and

increase access to treatment

• These results illustrate one small, specific

component of the much broader consequences of state failures to expand Medicaid

Summary of Findings

• States that failed to expand Medicaid are forgoing:

– Federally-subsidized coverage that increases access for individuals – Funding for BH infrastructure

• Medicaid is only one leg of the stool

– Private insurance: parity enforcement – Grant funding also remains critical – Venture capital

• If Medicaid is cut, grant funding will not be adequate

to backfill

Policy Implications

• Highlights importance of ACA outreach and

enrollment assistance: FQHCs are hubs

• Evan when increased funding for BH capacity is

available, will health centers be able to find staff to hire?

• Are evidence-based, quality treatment services being

provided?

– Screening and case identification? – Integrated, collaborative care? – Linkages to full continuum of services and supports, including social services?

Policy Implications

• Narrow focus on impact of Medicaid expansion

decisions on BH services in health centers

– Only includes encounters with specialists

• Projections based on 2012 patterns of spending on

various health center services

– Workforce shortages might constrain hiring

• Optimal level of mental health and substance use

disorder treatment capacity is unknown

– Demand might increase with capacity

Limitations

Jones, Zur, Rosenbaum, Ku. Opting Out of Medicaid Expansion: Impact on Encounters With Behavioral Health Specialty Staff in Community Health Centers. Psychiatric Services: https://www.ncbi.nlm.nih.gov/pubmed/26278224