About 20 percent of all Americans live with a behavioral health condition, but only half of this population receives treatment - with direct consequences that include poor physical health outcomes, increased health care costs, and reduced quality of life and life span. Barriers to obtaining behavioral health treatment are most evident in populations receiving Medicare, Medicaid, and Marketplace plans. Behavioral health care providers serving individuals enrolled in these plans are more likely to experience challenges around reimbursement and training, which disincentivizes participation. The Centers for Medicare & Medicaid Services and the Substance Abuse and Mental Health Services Administration asked the National Academies to convene an expert committee to examine current challenges in ensuring broad access to evidence-based behavioral health care services through Medicare, Medicaid, and Marketplace programs and propose strategies to address those challenges

Contents

• The National Academies of SCIENCES • ENGINEERING • MEDICINE
• COMMITTEE ON THE STRATEGIES TO IMPROVE ACCESS TO BEHAVIORAL HEALTH CARE SERVIES THROUGH MEDICARE AND MEDICAID
• Reviewers
• Acknowledgments
• Preface
• Acronyms and Abbreviations
• Summary
  • BEHAVIORAL HEALTH WORKFORCE AND STRUCTURAL BARRIERS
  • CHALLENGING INSURANCE PRACTICES
  • THE URGENT CALL FOR INNOVATION
  • FOCUSING ON THE INDIVIDUAL’S NEEDS
  • COMMITTEE GOALS AND RECOMMENDATIONS
• 1. Introduction
  • BACKGROUND
  • MEDICARE, MEDICAID, AND MARKETPLACE BENEFICIARIES
  • PROJECT ORIGIN AND STATEMENT OF TASK
  • SCOPE OF THE REPORT AND GUIDING PRINCIPLES
  • COMMITTEE’S APPROACH
  • ORGANIZATION OF THE REPORT
  • REFERENCES
• 2. Behavioral Health Needs in the United States
  • BEHAVIORAL HEALTH ACROSS THE LIFESPAN
  • UNMET BEHAVIORAL HEALTH NEEDS
  • REFERENCES
• 3. The U.S. Behavioral Health Care System
  • THE BEHAVIORAL HEALTH WORKFORCE
  • MEDICARE, MEDICAID, AND MARKETPLACE INSURANCE PROGRAMS
  • MEDICARE AND MEDICARE ADVANTAGE
  • MEDICAID AND CHIP
  • DUALLY ELIGIBLE BENEFICIARIES
  • MARKETPLACE PLANS
  • PAYMENT MODELS FOR BEHAVIORAL HEALTH SERVICES
  • SETTINGS FOR DELIVERING BEHAVIORAL HEALTH CARE
  • REFERENCES
• 4. Factors Contributing to the Expansion and Recruitment of Behavioral Health Providers Serving Medicare, Medicaid, and Marketplace Beneficiaries
  • WORKFORCE EDUCATION PROGRAMS
  • DIVERSE REPRESENTATION IN THE BEHAVIORAL HEALTH WORKFORCE
  • GRADUATE MEDICAL EDUCATION FUNDING
  • BILLING CAPABILITY FOR BEHAVIORAL HEALTH CARE PROVIDERS-IN-TRAINING IN MEDICARE, MEDICAID, AND ACA MARKETPLACE INSURANCES
  • BILLING COVERAGE OF NON-LICENSED BEHAVIORAL HEALTH PROVIDERS AND SERVICES
  • TELEHEALTH AND EXPANDED LICENSURE TO ADDRESS BEHAVIORAL HEALTH PROVIDER MALDISTRIBUTION
  • BILLING COVERAGE OF ADDITIONAL CLINICAL BEHAVIORAL HEALTH PROVIDERS AND SERVICES
  • CONCLUSIONS
  • REFERENCES
• 5. Enhancing Workforce Retention in Medicare, Medicaid, and Marketplaces: Key Factors at Play
  • REIMBURSEMENT AS A DRIVER OF BEHAVIORAL HEALTH CARE PROVIDER PARTICIPATION
  • RISING COSTS MAY RESTRICT NEEDED INVESTMENT IN WORKFORCE: THE ROLE OF COST CONTAINMENT
  • ADMINISTRATIVE BARRIERS
  • OTHER BURDENS AND STRESS FACTORS THAT LEAD TO ATTRITION, BURNOUT, OR DISSATISFACTION
  • INTEGRATING CARE TO IMPROVE BEHAVIORAL HEALTH CARE PROVIDER SATISFACTION
  • CONCLUSIONS
  • REFERENCES
• 6. Innovative Infrastructure: Balancing Support and Challenges for the Behavioral Health Workforce in Medicare, Medicaid, and Marketplace
  • PAYMENT SYSTEM INCENTIVES THAT AFFECT WORKFORCE PARTICIPATION
  • REGULATING HEALTH CARE PROVIDER NETWORKS IN MEDICARE, MEDICAID, AND MARKETPLACE
  • TELEHEALTH: AN INFRASTRUCTURE FOR ADVANCING OR LIMITING HEALTH CARE PROVIDER PARTICIPATION
  • PAYMENT MODELS: BARRIERS AND FACILITATORS FOR HEALTH CARE PROVIDER PARTICIPATION
  • BI-DIRECTIONAL INTEGRATION OF BEHAVIORAL HEALTH, PRIMARY CARE, AND GENERAL HEALTH
  • ADDRESSING COMPLEX NEEDS
  • CONCLUSIONS
  • REFERENCES
• 7. Recommendations
  • RECOMMENDATIONS
  • REFERENCE
• Appendix A. Committee and Staff Biographies
• Appendix B. Disclosure of Unavoidable Conflict of Interest
• Appendix C. Chapter 3 Tables
• Appendix D. Public Meeting Agendas
• Appendix E. Exploring Strategies to Improve Access to Behavioral Health Care Services Through Medicare and Medicaid: Proceedings of a Workshop—in Brief
• Appendix F. Recommendations and Conclusions Matrix

Suggested citation:

National Academies of Sciences, Engineering, and Medicine. 2024. Expanding behavioral health care workforce participation in Medicare, Medicaid, and Marketplace plans. Washington, DC: The National Academies Press. https://doi.org/10.17226/27759.

Digital Object Identifier: https://doi.org/10.17226/27759

This publication is available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.

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