How state Medicaid programs are responding to the behavioral health crisis

New research shows that 33 states do not provide Medicaid coverage for the three main crisis services that should be available for those who need behavioral health support: crisis hotlines, crisis motives and crisis stabilisation.

The Substance Abuse and Mental Health Services Administration (SAMHSA) has identified them as necessary services for people in crisis. The Kaiser Family Foundation (KFF) released the analysis Thursday when interviewing state Medicaid officials. Responses came from 44 states and the District of Columbia. One reason to investigate Medicaid state leaders is that Medicaid is the largest payer of behavioral health services in the United States and 39% of the Medicaid population has a mental health disorder or of drug addiction.

Crisis hotline refers to telephone numbers that individuals can call to be connected with trained crisis counsellors. Mobile Crisis Units provide in-person support to people in need of behavioral health services, sometimes at the individual’s home. Crisis stabilization units provide short-term observation in a non-hospital setting.

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

The analysis revealed that 41 states (including DC) cover at least basic crisis service. Only 12 states (including DC) cover all three major crisis services, 18 states cover two, and 11 states cover one. Florida, Indiana, Maryland and Wyoming do not cover any. 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 hotlines are available free to anyone in every state, but some Medicaid programs help fund crisis hotlines by reimbursing crisis hotlines. crisis, which may include 988 or other direct lines,” KFF said. “One of the reasons that coverage for this emergency service is lower than others may be the difficulty in obtaining insurance information on emergency calls.”

There are several barriers to implementing crisis services, the report also says. Almost all of the responding states, 38, are experiencing labor shortages. Another 36 states cited geographic challenges, such as travel times in rural areas resulting in longer response times. In addition, 24 states indicated a need for additional training for crisis professionals and 10 states indicated that there are “scope of practice limitations.” The latter refers to the fact that some state licensing boards do not clearly define the roles and responsibilities of unlicensed personnel.

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

Photo: Wacharaphong, Getty Images

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