TABLE 5-4Selected Quotes from the Committee’s RFI on Behavioral Health Workforce Experience by Setting

Behavioral Health Care Provider Setting Comment or Critique
Academic medical setting“Medicare and Medicaid are huge barriers in the ability to provide the necessary services needed for those with severe mental illnesses—it does not allow for the reimbursement of occupational therapy services within a mental health space, even though the foundations of the profession are in mental health.”
“I do take Medicaid, but most of my colleagues do not because the reimbursement is SO low and the patient needs SO high.”
Academic medical school“Insurance providers do not adequately recognize and reimburse for services provided by licensed marriage and family therapists (LMFTs) and associate or provisionally licensed LMFTs. This inhibits growth of the mental health workforce and patient/client access to care.”
“There is significant variability in rates, especially for behavioral health. Insurance pays significantly less than private pay clients and often does not reimburse out of network for people who are desperate to be seen. The paperwork is significant and a drawback.”
Community center“Although I have years of experience in inpatient psychiatric facilities, currently the work I do is community-based and pro bono or grant funded.”
“Medicare, Medicaid, and private insurance was used for inpatient acute crises but is not widely available to help folks in the community avoid costly hospitalization.”
“My experience is with Medicaid, but it starts with the social workers. They are so behind on assessments and therefore delays the coverage of services. If and when the client/patient calls 211, the hold to get assistance in your case is overwhelming.”
Community mental health center“While recognizing the roles of accountability of providers, some requirements are onerous and distract provider time and effort away from direct care.”
“I have experience with Medicaid (state-level government-sponsored insurance). It is frequently needlessly bureaucratic, wildly inefficient, and confusing both to providers and consumers.”
Group practice“I have had a few problems with Medicare processing claims correctly. It is challenging and time consuming to get claims that were processed incorrectly fixed. Medicaid reimburses poorly. Marketplace insurance programs vary on reliability of claim processing and often reimburse poorly. I have considered numerous times getting off these panels.”
Hospital“As a psychologist in a large health care system, I do not have direct engagement in billing or accounts receivable, but I do hear constant challenges of extremely high co-pays for private insurance, the complete lack of affordability for Marketplace insurance, and high demand for prior authorization for treatments, both procedural and prescription, covered by Medicare and Medicaid, which leads to dangerous delays in care and creates a backlog in patient access, as providers are forced to step away from direct patient care and instead engage with insurance panels to argue the necessity of their treatment plans.”
“Within the hospital our reimbursements for these payers are so low that we take a loss providing the services. That’s really 100 percent of the story to be honest.”

From: 5, Enhancing Workforce Retention in Medicare, Medicaid, and Marketplaces: Key Factors at Play

Cover of Expanding Behavioral Health Care Workforce Participation in Medicare, Medicaid, and Marketplace Plans
Expanding Behavioral Health Care Workforce Participation in Medicare, Medicaid, and Marketplace Plans.
National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Health Care Services; Committee on Strategies to Improve Access to Behavioral Health Care Services through Medicare and Medicaid; Perera U, Godwin A, Polsky D, editors.
Washington (DC): National Academies Press (US); 2024 Oct 7.
Copyright 2024 by the National Academy of Sciences. All rights reserved.

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