Medicaid physical and behavioral health coverage does not increase access or care

The concept that mental health should be treated on par with physical health has progressively gained acceptance in the United States, particularly in light of rising rates of anxiety and depression during and after the COVID-19 epidemic. Many Medicaid programs have forced their managed care organizations to pay for behavioral health and physical health simultaneously in order to promote access to mental health treatment. In contrast to the old system, mental health, including treatment for substance use disorders, was “carved out” of standard health care coverage, forcing patients to obtain coverage via a whole distinct insurance plan.

The new strategy, known as integrated managed care organizations, was expected to improve patient access and outcomes.

A new study sponsored by Oregon Health & Science University, however, finds that integrating behavioral and physical health did not result in significant changes in access or quality of health care in the state of Washington.

“There was hope that this would be a significant catalyst,” said lead author and OHSU Center for Health Systems Effectiveness director John McConnell, Ph.D. “The idea was that integrating care within managed care organizations would drive positive changes at the clinical level, and that didn’t really happen — at least not yet.”

The study, published in JAMA Health Forum, concluded that while the administrative reform is required, it is insufficient on its own to enhance patients’ access, quality, and overall health outcomes.

McConnell believes that achieving those outcomes may necessitate new training and incentives, such as shifting from traditional fee-for-service payment models — in which providers are paid for each medical visit — to alternatives such as those that pay providers for a set number of patients covered by the practice overall.

The improvements were researched in Washington state, which has been a pioneer in pushing integrated care models to improve mental health treatment.

The current study looked at claims-based metrics like mental health visits, health outcomes like reported incidences of self-harm, and general quality of life measures like arrests, employment, and homelessness among 1.4 million Medicaid patients in Washington state. Between 2014 and 2019, the analysis monitored a staggered implementation of financial integration across Washington’s 39 counties.

“The surprising result was that nothing really changed,” McConnell explained.

Although researchers were unable to detect statistically significant gains in access or outcomes for patients across Washington, McConnell highlighted that financial integration did not worsen problems. That’s significant, he added.

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