Medicaid’s Role in Financing Behavioral Health Services for Low-Income Individuals

Issue Brief
  1. Committee to Evaluate the Supplemental Security Income Disability Program for Children with Mental Disorders; Board on the Health of Select Populations; Board on Children, Youth, and Families; Institute of Medicine; Division of Behavioral and Social Sciences and Education; The National Academies of Sciences, Engineering, and Medicine, Mental Disorders and Disabilities Among Low-Income Children, ed. Boat TF and Wu JT, (Washington, DC: National Academies Press (US); October 2015), http://www.ncbi.nlm.nih.gov/pubmed/26632628.

     

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  2. Jitender Sareen, et al., “Relationship Between Household Income and Mental Disorders: Findings From a Population-Based Longitudinal Study,” Archives of General Psychiatry, 68, 4(2011):419-27.

     

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  3. Bridget F. Grant, et al., “Epidemiology of DSM-5 Alcohol Use Disorder: Results From the National Epidemiologic Survey on Alcohol and Related Conditions III,” JAMA Psychiatry, 72, 8(2015):757-66.

     

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  4. Kaiser Family Foundation analysis of 2015 National Survey on Drug Use and Health.

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  5. [v] Ibid.

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  6. [vi] Center for Behavioral Health Statistics and Quality, 2015 National Survey on Drug Use and Health: Detailed Tables (Rockville, MD: Substance Abuse and Mental Health Services Administration, September 2016), https://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs-2015/NSDUH-DetTabs-2015/NSDUH-DetTabs-2015.pdf

     

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  7. Kaiser Family Foundation analysis of 2015 National Survey on Drug Use and Health

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  8. Tricia Brooks et al., Medicaid and CHIP Eligibility, Enrollment, Renewal, and Cost Sharing Policies as of January 2017: Findings from a 50-State Survey (Washington, DC: Kaiser Family Foundation, January 2017), https://www.kff.org/medicaid/report/medicaid-and-chip-eligibility-enrollment-renewal-and-cost-sharing-policies-as-of-january-2017-findings-from-a-50-state-survey/.

     

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  9. Medicaid and CHIP Payment and Access Commission (MACPAC), Report to Congress on Medicaid and CHIP (Washington, DC: MACPAC, June 2015), https://www.macpac.gov/wp-content/uploads/2015/06/June-2015-Report-to-Congress-on-Medicaid-and-CHIP.pdf.

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  10. [x] States that elect the § 209 (b) option are permitted to use definitions of disability or financial eligibility standards that are more restrictive than the federal SSI rules, so long as the state’s rules are not more restrictive than those in effect in January 1972.  Section 209 (b) states must allow SSI beneficiaries to establish Medicaid eligibility through a spend-down by deducting unreimbursed out-of-pocket medical expenses from their countable income.  Section 209 (b) states also must provide Medicaid to children who receive SSI and who meet the state’s financial eligibility rules for the AFDC program as of July 16, 1996.

     

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  11. Molly O’Malley Watts, et al., Medicaid Financial Eligibility for Seniors and People with Disabilities in 2015 (Washington, DC: Kaiser Family Foundation, March 2016), https://www.kff.org/medicaid/report/medicaid-financial-eligibility-for-seniors-and-people-with-disabilities-in-2015/.

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  12. Medicaid and CHIP Payment and Access Commission (MACPAC), Report to Congress on Medicaid and CHIP (Washington, DC: MACPAC, June 2015), https://www.macpac.gov/wp-content/uploads/2015/06/June-2015-Report-to-Congress-on-Medicaid-and-CHIP.pdf.

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  13. Medicaid and CHIP Payment and Access Commission (MACPAC), Report to Congress on Medicaid and CHIP (Washington, DC: MACPAC, June 2015), https://www.macpac.gov/wp-content/uploads/2015/06/June-2015-Report-to-Congress-on-Medicaid-and-CHIP.pdf.

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  14. [xiv] Ibid.

     

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  15. Ibid.

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  16. Ibid.

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  17. Ibid.

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  18. Substance Abuse and Mental Health Services Administration, Medicaid Handbook: Interface with Behavioral Health Services (Rockville, MD: US Department of Health and Human Services, 2013), http://store.samhsa.gov/shin/content//SMA13-4773/SMA13-4773.pdf.

     

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  19. Julia Paradise and MaryBeth Musumeci, CMS’s Final Rule on Medicaid Managed Care: A Summary of Major Provisions (Washington, DC: Kaiser Family Foundation, June 2016), https://www.kff.org/medicaid/issue-brief/cmss-final-rule-on-medicaid-managed-care-a-summary-of-major-provisions/.

     

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  20. Centers for Medicare & Medicaid Services, New Service Delivery Opportunities for Individuals with a Substance Use Disorder (Baltimore, MD: Centers for Medicare & Medicaid Services, July 2015), https://www.medicaid.gov/federal-policy-guidance/downloads/SMD15003.pdf.

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  21. Substance Abuse and Mental Health Services Administration, Medicaid Handbook: Interface with Behavioral Health Services (Rockville, MD: US Department of Health and Human Services, 2013), http://store.samhsa.gov/shin/content//SMA13-4773/SMA13-4773.pdf.

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  22. [xxii] MaryBeth Musumeci and Henry Claypool, Olmstead’s Role in Community Integration for People with Disabilities Under Medicaid: 15 Years After the Supreme Court’s Olmstead Decision (Washington, DC: Kaiser Family Foundation , June 2014), https://www.kff.org/medicaid/issue-brief/olmsteads-role-in-community-integration-for-people-with-disabilities-under-medicaid-15-years-after-the-supreme-courts-olmstead-decision/.

     

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  23. 42 U.S.C. § 1396u-7; 42 U.S.C. § 1396a (k) (1); 42 C.F.R. § § 440.300-440.390.  Beneficiaries who are “medically frail” cannot be required to receive an ABP and instead must have access to the state plan benefit package.  42 U.S.C. § 1396u-7 (a) (2) (vi); 42 C.F.R. § 440.315 (f).

     

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  24. States that expanded Medicaid can choose to align their ABP for expansion adults with their Medicaid state plan benefit package. However, in states that do not align the two benefit packages, adult beneficiaries may have access to different behavioral health and other services based on their eligibility pathway. In these states, people who qualify for Medicaid both through a disability-related pathway and based on their low income can choose their coverage group and, therefore, their benefit package.

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  25. [xxv] MaryBeth Musumeci, Behavioral Health Parity and Medicaid (Washington, DC: Kaiser Family Foundation, June 2015), http://www.kff.org/report-section/behavioral-health-parity-and-medicaid-issue-brief/.

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  26. [xxvi] CMS has published a final rule that applies federal mental health parity requirements to all Medicaid services provided to MCO enrollees, whether those services are delivered on a capitated or FFS basis.

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  27. [xxvii] Ken Cannon, Jenna Burton, and MaryBeth Musumeci, Adult Behavioral Health Benefits in Medicaid and the Marketplace (Washington, DC: Kaiser Family Foundation, June 2015), https://www.kff.org/medicaid/report/adult-behavioral-health-benefits-in-medicaid-and-the-marketplace/.

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  28. [xxviii] 42 U.S.C. § § 1396a (a) (43), 1396d (r) (5).

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  29. [xxix] Substance Abuse and Mental Health Services Administration, Medicaid Handbook: Interface with Behavioral Health Services (Rockville, MD: US Department of Health and Human Services, 2013), http://store.samhsa.gov/shin/content//SMA13-4773/SMA13-4773.pdf.

     

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  30. Vernon K. Smith, et al., Implementing Coverage and Payment Initiatives: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2016 and 2017 (Washington, DC: Kaiser Family Foundation, October 2016), https://www.kff.org/medicaid/report/implementing-coverage-and-payment-initiatives-results-from-a-50-state-medicaid-budget-survey-for-state-fiscal-years-2016-and-2017/.

     

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  31. Ibid.

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  32. Ibid.

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  33. [xxxiii] Mike Nardone, Sherry Snyder, and Julia Paradise, Integrating Physical and Behavioral Health Care: Promising Medicaid Models (Washington, DC: Kaiser Family Foundation, February 2014) https://www.kff.org/medicaid/issue-brief/integrating-physical-and-behavioral-health-care-promising-medicaid-models/.

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  34. [xxxiv] David Mechanic and Mark Olfson, “The Relevance of the Affordable Care Act for Improving Mental Health Care.” Annual Review of Clinical Psychology 12 (2016):515-42.  

     

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  35. Medicaid and CHIP Payment and Access Commission (MACPAC), Report to Congress on Medicaid and CHIP (Washington, DC: MACPAC, March 2016), https://www.macpac.gov/wp-content/uploads/2016/03/March-2016-Report-to-Congress-on-Medicaid-and-CHIP.pdf.

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  36. Center for Health Care Strategies, Medicaid Health Homes: Implementation Update, (Hamilton, NJ: Center for Health Care Strategies, Inc., January 2017), http://www.chcs.org/media/Health_Homes_FactSheet-01-18-17.pdf.

     

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  37. Molly O’Malley Watts, et al., Medicaid Financial Eligibility for Seniors and People with Disabilities in 2015 (Washington, DC: Kaiser Family Foundation, March 2016), https://www.kff.org/medicaid/report/medicaid-financial-eligibility-for-seniors-and-people-with-disabilities-in-2015/.

     

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  38. MaryBeth Musumeci and Henry Claypool, Olmstead’s Role in Community Integration for People with Disabilities Under Medicaid: 15 Years After the Supreme Court’s Olmstead Decision (Washington, DC: Kaiser Family Foundation , June 2014), https://www.kff.org/medicaid/issue-brief/olmsteads-role-in-community-integration-for-people-with-disabilities-under-medicaid-15-years-after-the-supreme-courts-olmstead-decision/.

     

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  39. Medicaid and CHIP Payment and Access Commission, Behavioral health services covered under HCBS waivers and 1915(i) SPAs (Washington, DC: Medicaid and CHIP Payment and Access Commission, September 2015), https://www.macpac.gov/subtopic/behavioral-health-services-covered-under-hcbs-waivers-and-spas/.

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  40. Molly O’Malley Watts, Erica L. Reaves, and MaryBeth Musumeci, Money Follows the Person: A 2015 State Survey of Transitions, Services, and Costs (Washington, DC: Kaiser Family Foundation, October 2015), https://www.kff.org/medicaid/report/money-follows-the-person-a-2015-state-survey-of-transitions-services-and-costs/.

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  41. Kaiser Family Foundation Analysis of 2015 National Survey on Drug Use and Health.

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  42. [xlii] Lisa Clemans-Cope, et al, “The Expansion of Medicaid Coverage under the ACA: Implications for Health Care Access, Use, and Spending for Vulnerable Low-income Adults,” Inquiry 50, 2(2013):135-49.

     

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  43. Hefei Wen, Benjamin G. Druss, and Janet R. Cummings, “Effect of Medicaid Expansions on Health Insurance Coverage and Access to Care among Low-Income Adults with Behavioral Health Conditions,” Health Services Research 50, 6(2015):1787-809.

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  44. [xliv] Katherine Baicker, et al., “The Oregon Experiment – Effects of Medicaid on Clinical Outcomes,” New England Journal of Medicine. 368, 18(2013):1713-22.

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  45. [xlv] Elizabeth Reisinger Walker, et al., “Insurance Status, Use of Mental Health Services, and Unmet Need for Mental Health Care in the United States,” Psychiatric Services, 66, 6(2015):578-84.

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  46. [xlvi] Center for Behavioral Health Statistics and Quality, 2015 National Survey on Drug Use and Health: Detailed Tables (Rockville, MD: Substance Abuse and Mental Health Services Administration, September 2016), https://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs-2015/NSDUH-DetTabs-2015/NSDUH-DetTabs-2015.pdf.

     

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  47. Substance Abuse and Mental Health Services Administration, Report to Congress on the Nation’s Substance Abuse and Mental Health Workforce Issues (Rockville, MD: US Department of Health and Human Services, January 2013), https://store.samhsa.gov/shin/content/PEP13-RTC-BHWORK/PEP13-RTC-BHWORK.pdf.

     

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  48. Tara F. Bishop, et al., “Acceptance of Insurance by Psychiatrists and the Implications for Access to Mental Health Care,” JAMA Psychiatry, 71, 2(2014):176-81.

     

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  49. Richard G. Frank, Kirsten Beronio, and Sherry A. Glied, “Behavioral Health Parity and the Affordable Care Act,” Journal of Social Work in Disability & Rehabilitation, 13, 1-2(2014):31-43.

     

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  50. Ramin Mojtabai, Mark Olfson, Nancy Sampson, et al., “Barriers to Mental Health Treatment: Results from the National Comorbidity Survey Replication,” Psychological Medicine, 41, 8(2011):1751-61.

     

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  51. Ramin Mojtabai, Lian Yu Chen, Christopher Kaufmann, et al., “Comparing Barriers to Mental Health Treatment and Substance Use Disorder Treatment Among Individuals with Comorbid Major Depression and Substance Use Disorders,” Journal of Substance Abuse Treatment, 46, 2(2014)268-73.

     

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  52. Kaiser Family Foundation, The Role of Medicaid for People with Behavioral Health Conditions (Washington, DC: Kaiser Family Foundation, November 2012), https://www.kff.org/wp-content/uploads/2013/01/8383_bhc.pdf.

     

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  53. Ibid.

     

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  54. Full-benefit dual eligibles and seniors were included; however, partial-benefit enrollees and states with incomplete or low-quality managed care encounter data (11 states including DC) were excluded from the analysis.

     

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  55. Medicaid and CHIP Payment and Access Commission (MACPAC), Report to Congress on Medicaid and CHIP (Washington, DC: MACPAC, June 2015), https://www.macpac.gov/wp-content/uploads/2015/06/June-2015-Report-to-Congress-on-Medicaid-and-CHIP.pdf.

     

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  56. Tami L. Mark, Tracy Yee, Katharine R. Levit, et al. “Insurance Financing Increased for Mental Health Conditions But Not For Substance Use Disorders, 1986-2014,” Health Affairs (Millwood) 35, 6(2016):958-965.

     

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  57. Ibid.

     

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  58. Congressional Budget Office, H.R. 1628 American Health Care Act of 2017 Cost Estimate (Washington, DC: Congressional Budget Office, May 2017), https://www.cbo.gov/system/files/115th-congress-2017-2018/costestimate/hr1628aspassed.pdf.

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  59. Ronald C. Kessler, et al., “Depression in the Workplace: Effects on Short-Term Disability,” Health Affairs, 18, 5(1999):163-71.

     

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  60. Neil Jordan, et al., “Economic Benefit of Chemical Dependency Treatment to Employers,” Journal of Substance Abuse Treatment, 34, 3(2008):311-319.

     

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  61. Doris J. James and Lauren E. Glaze. Mental Health Problems of Prison and Jail Inmates (Washington, DC: US Department of Justice, December 2006), https://www.bjs.gov/content/pub/pdf/mhppji.pdf.

     

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  62. Cheryl J. Cherpitel and Yu Ye, “Drug Use and Problem Drinking Associated with Primary Care and Emergency Room Utilization in the US General Population: Data from the 2005 National Alcohol Survey,” Drug and Alcohol Dependence, 97, 3(2008):226-230.

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