How State Medicaid Programs Are Responding to the Behavioral Health Crisis

How State Medicaid Programs Are Responding to the Behavioral Health Crisis
How State Medicaid Programs Are Responding to the Behavioral Health Crisis

New research shows that 33 states do not provide Medicaid coverage for all three core crisis services that should be available to those in need of behavioral health support: crisis hotlines, mobile crisis units and crisis stabilization.

The Substance Abuse and Mental Health Services Administration (SAMHSA) identified these as necessary services for those in a crisis. The Kaiser Family Foundation (KFF) published the analysis Thursday by surveying state Medicaid officials. Responses came from 44 states and the District of Columbia. One reason for surveying state Medicaid leaders is because Medicaid is the largest payer of behavioral health services in the U.S., and 39% of the Medicaid population has a mental health or substance use disorder condition.

The crisis hotline refers to phone numbers individuals can call to be connected to trained crisis counselors. Mobile crisis units offer in-person support for those in need of behavioral health services, sometimes in the individual’s home. Crisis stabilization units provide short-term observation in non-hospital settings.

Literature has shown that crisis services divert people away from psychiatric hospitalization and reduce the need for intervention within emergency departments or by law enforcement. … Without access to necessary evidence-based care, mental health crises can worsen or prolong,” KFF said.

The analysis found that 41 states (including D.C.) cover at least one core crisis service. Just 12 states (including D.C.) cover all three core crisis services, 18 states cover two and 11 states cover one. Florida, Indiana, Maryland and Wyoming cover none. Alabama, Arkansas, Delaware, New Hampshire, Minnesota and Utah did not respond to the survey.

The most commonly covered service is mobile crisis units, with 33 states covering it. Another 28 states cover crisis stabilization units and 22 cover crisis hotlines.

“Crisis hotline services are available to anyone free of charge across all states, but some Medicaid programs help to finance crisis hotlines by reimbursing crisis hotline services, which might include 988 or other hotlines,” KFF said. “One reason why coverage for this crisis service is lower than others may be the difficulty in obtaining insurance information during emergency crisis calls.”

There are several barriers to implementing crisis services, the report also shows. Almost all of the responding states, or 38, experience workforce shortages. Another 36 states cited geography challenges, such as travel times in rural areas that lead to longer response times. In addition, 24 states listed needing additional training for crisis professionals and 10 states said there are “scope-of-practice limitations.” The latter refers to the fact that some state licensing boards don’t clearly define the roles and responsibilities of non-licensed staff.

There is an option for enhanced federal funding for crisis services, however. More than half of the responding states (28) are implementing or plan to implement the American Rescue Plan Act mobile crisis intervention services option. This would provide 85% enhanced federal matching funds for the first three years of implementation to Medicaid programs that offer community-based mobile crisis services.

Photo: Wacharaphong, Getty Images

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