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Obstacles to Behavioral Health Services Increasingly Difficult for Medicaid Populations


Misty’s young son was diagnosed with ADHD, but she can’t afford to take unpaid time off from work to take him to behavior therapy. After hurting his back on the job, Jack became depressed and addicted to painkillers, yet he’s too proud to get help. Driving an hour to see a psychologist who accepts Medicaid is a treatment barrier for Kim, who suffers from debilitating anxiety. Crystal’s afraid she’ll run into someone she knows in her local therapist’s waiting room, so her obsessive compulsive disorder continues to disrupt her life. And Tom’s PTSD goes untreated because his housing instability leads to fragmented care.

These are just a few of the many faces within the Medicaid population who struggle with accessing the behavioral health services they or their loved ones need to treat, manage and monitor their condition.

Mental health and substance abuse disorders, especially when untreated, raise the risk for disability and adverse physical health conditions, like hypertension, heart disease and diabetes, ultimately increasing the overall cost of care.

One in five Medicaid recipients has a behavioral health diagnoses, and they account for almost half of total Medicaid expenditures — an excess of $131 billion.

These numbers, however, may understate the true prevalence and cost of mental health conditions among Medicaid beneficiaries as it’s not uncommon for such conditions to go undiagnosed, unreported or untreated among this often undeserved, transient and elusive population.

From housing insecurity to provider shortages
Numerous barriers prevent Medicaid enrollees from receiving behavioral health treatment, such as financial strain, housing insecurity, inadequate transportation, low health literacy, language barriers, and time and mobility constraints.

Uncomfortable feelings, like fear, embarrassment and shame, a lack of motivation, denial, and the stigma often surrounding therapy are also common roadblocks. While many of these barriers are present across all populations, for Medicaid beneficiaries, they are often higher and harder to surmount.

Limited access to care is another obstacle many Medicaid recipients encounter. A variety of factors contribute to insufficient provider access, including state budget cuts that have reduced mental health and substance abuse services as well as notoriously low reimbursement rates that prevent many providers from accepting Medicaid patients.

In addition, the influx of new Medicaid enrollees who became eligible for coverage under the Affordable Care Act has many Medicaid providers bursting at the seams, leading to long appointment wait times and provider offices no longer accepting new patients.

And, like primary care physicians, there’s a growing shortage of behavioral health providers, especially in rural and inner-city areas.

Nearly 91 million Americans reside in an area with a shortage of mental health professionals to support their needs, according to the U.S. Health and Human Services Health Resources and Services Administration. In a report to Congress, the agency reported that 55% of the country’s 3,100 counties have no practicing psychiatrists, psychologists or social workers.

Virtual behavioral healthcare removes obstacles
Medicaid is the single largest payer in the U.S. for behavioral health services. Thus, it’s not surprising that federal and state policymakers, along with the private managed care plans that cover nearly 80 percent of the nation’s Medicaid enrollees, are constantly seeking strategies for enhancing access to cost-effective, high-quality behavioral health services.

Better access for this population would decrease the cost of their overall healthcare, reduce the nation’s healthcare spending, and help millions of people live healthier, more productive lives.

Telehealth, or virtual care, is one form of care delivery that more and more policymakers, providers and payers are embracing to elevate patient access to both physical and mental health care.

By providing counseling services via videoconference and telephone, virtual behavioral health consultations — also referred to as teletherapy, telepsychology, telepsychiatry, telemental health and telebehavioral health — remove many of the obstacles that hinder Medicaid beneficiaries, especially those in underserved communities, from getting treatment.

When patients can confidentially meet with a behavioral health specialist remotely (and even after hours) from the ease and convenience of home, work, or another private location, their treatment isn’t derailed by hindrances such as inconvenient driving distances, long wait times for face-to-face appointments, limited office hours, or a shortage of qualified providers in their area.

Removing these hurdles reduces the chance of fragmented care or lack of care, leading to better outcomes and cost savings.

While states have varying regulations and restrictions regarding which telehealth technologies and services are allowable and reimbursable, support of this alternate healthcare delivery option is rapidly escalating.


For nearly 30 years, Carenet Health has been serving millions of Medicaid beneficiaries. We deeply understand the many challenges providers, payers and patients face when it comes to accessing care. Our Virtual Clinic, the industry’s only telehealth solution that seamlessly combines up-front nurse triage with virtual MD and behavioral health consults, can be an essential component for effective care and access 24 hours a days, seven days a week.

To learn more, download our ebook: Succeeding in the Ever-Changing Medicaid Landscape.