This month marks the 70th anniversary of Mental Health Awareness Month. The observance began in 1949 to create awareness of the struggles faced by those living with mental health conditions.

Since 1949, advancements in science and studies have enabled healthcare professionals and insurance providers to make distinctions between conditions caused by mental health and behavioral health. Mental health refers to a person’s psychological and emotional well-being largely based on biological factors (brain chemistry) and life experiences. Behavioral health focuses on behaviors that can adversely impact a person’s mental health, such as eating, exercise, addiction, and sleep habits. While these classifications can be intertwined, distinguishing one from the other can factor into treatment.

Are we truly aware?

The question on the table as we exit our 70th month of May for mental health awareness is, how are we progressing in providing support for those living with a mental health condition and conveying a clear message of how to receive care? The recent numbers are not favorable.

Studies indicate that one in every five adults in America experiences mental illness in a year and seven of every 10 Americans are diagnosed with behavioral health issues. But the most alarming statistic was presented in February, 2019 by Mental Health First USA. In the U.S., only 41 percent of the people who had a mental disorder in the past year received professional health care or other services. That means more than half of those who need care are not receiving care.

Fear of stigmatism continues to be a deterrent for those in need of help, but nearly 25 percent of Americans that forego mental health care contend they either can’t afford it or their health insurance won’t cover it.

Awareness of funding support is critical to chipping away at those unfavorable numbers. Citizens, health care facilities, managed care organizations, and providers need to stay informed of all viable options for funding reimbursement. Medicaid has been at the forefront of supporting mental health services and is the single largest payer for mental health services in the United States. Improving care for beneficiaries with Serious Mental Illness (SMI) or Serious Mental Disorder (SMD) is now a top priority for the Centers for Medicare & Medicaid Services (CMS).

Three areas of focus for CMS and Children’s Health Insurance Program (CHIP) for the next several years:

  • Effective benefit design for mental health services for children, youth, and their families
  • Effective benefit design for substance use disorder services
  • Mental Health Parity and Addiction Equity Act (MHPAEA) application to Medicaid programs

The Mental Health Parity and Addiction Equity Act (MHPAEA, Pub.L. 110-343) assists Americans with mental health and substance use disorders to receive the care they need by prohibiting certain discriminatory practices that limit insurance coverage for behavioral health treatment and services. MHPAEA requires coverage for mental health and substance use disorders to be no more restrictive than the coverage that generally is available for medical/surgical conditions.

The Institute for Medicaid Innovation

Another exceptional organization emerged in 2016 when the Institute for Medicaid Innovations (IMI) was formed. Its mission is to improve the lives of Medicaid enrollees through the development, implementation, and diffusion of innovative and evidence-based models of care that promote quality, value, equity, and the engagement of patients, families, and communities.

IMI’s work in behavioral health includes research and initiatives in Medicaid managed care for maternal depression, anxiety, and opioid abuse. Other areas of focus for Medicaid innovation at IMI are women’s health, disparities and equity, child health, and best practices. Their website also provides information to access quality care specific to each state.

There is a far greater understanding and acknowledgment of mental and behavioral health conditions today than there was 70 years ago. The progress is indisputable. The challenge moving forward is defining the options for receiving care and financial reimbursement.

To learn more about the most recent innovations in Medicaid funding, contact Chad Wallace, Vice President at HRSI.