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Medicaid recipients may still face mental health care constraints

More than one-third of counties in the United States do not provide mental health services that accept Medicaid, and despite the federal program's expansion to include all individuals with income below 133% of the national poverty level, certain populations may still face a significant barrier to mental health care, researchers reported.

"Although the expansion of Medicaid will provide an opportunity to increase insurance coverage for vulnerable populations in need of [mental health] services, many communities may face constraints on the Medicaid [mental health] safety-net system to meet the increase demand for services — especially rural communities and communities with large percentages of black and Hispanic residents," Janet R. Cummings, PhD, of the department of health policy and management at Emory University, and colleagues wrote.

To determine the availability of outpatient mental health facilities in the United States that accept Medicaid, Cummings and colleagues merged data from the 2008 National Survey of Mental Health Treatment Facilities and the Area Resource File — a database of county-level health resources. The researchers also examined the association between a county's sociodemographic characteristics and the availability of mental health services to its Medicaid enrollees. The final analyses included a sample of 3,141 counties across the United States.

Of the 3,141 counties with facilities that provide mental health care services, 34.8% do not accept Medicaid. These counties were more likely to have a larger percentage of residents living in rural areas (marginal effect [ME]=27.9%; 95% CI, 25.3-30.4) and residents who are black (ME=3.9%; 95% CI, 1.2-6.6) and Hispanic (ME=4.8%; 95% CI, 2.3-7.4).

The researchers said there are several options to extend mental health services to Medicaid enrollees, including building new facilities or revising Medicaid policies to encourage solo or group providers to accept the federal program. However, both options present significant challenges to states struggling with budget constraints.

"A more practical strategy to improve access to community-based [mental health] services for Medicaid enrollees in vulnerable communities would be to allocate more funds for primary care safety-net facilities to improve their capacity to provide specialty services," they wrote. Those funds, they added, could come from the Patient Protection and Affordable Care Act, which has allocated $11 billion for existing community health centers to provide oral health, pharmacy and behavioral health services.

"Policymakers need to recognize the continued importance of enhancing behavioral health services in primary care safety-net facilities to help meet the increased demand for [mental health services] among states that opt into Medicaid, especially communities that lack an adequate [mental health] safety-net system," the researchers concluded.

Disclosure: The researchers report no relevant financial disclosures.