The January 2023 decision by the Centers for Medicare & Medicaid Services (CMS) to approve an amendment to New York’s Medicaid section 1115 waiver is a welcome step forward in the expansion of accessible and affordable mental healthcare at a time of increasing need.
A commitment to improved mental health rests at the core of the $7.5B waiver, which will enable New York State to invest nearly $6B of federal funding into the state’s healthcare system over the next three years. The state can now integrate primary and behavioral healthcare services to improve health equity for high-risk populations, including children, maternal patients, and those with substance use disorders (SUDs).
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As federal and state governments continue to emphasize the need for integrated care, a renewed commitment to funding and supporting child, perinatal, and SUD psychiatry access programs will be central to this effort. Access programs – which support primary care providers to deliver behavioral healthcare through education, training, and specialty peer-to-peer psychiatric consultations – are being implemented in nearly every state in the nation to provide accessible behavioral healthcare amidst a scarcity of providers and resources.
By expanding access to scarce behavioral health resources, access programs ensure that essential specialty care can be delivered to vulnerable groups that need it most urgently. This expansion not only improves accessibility but also helps limit the burden on an already overstretched system of behavioral health providers. It may also represent a cost saving to governments, allowing specialty-level care to be administered by less costly primary care providers within the health system.
Yet, with many programs reliant on time-limited federal or state grants for operations, stable, recurring funding is essential. Far fewer have access to stable, recurring funding through alternate sources. For state access programs to continue expanding care, federal and state governments must commit ongoing resources to their sustainability and growth.
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If we are to continue bridging these gaps, federal agencies and state legislators must consider allocating recurring funds to access programs across the nation.
The nation’s first access program, the Massachusetts Child Access Psychiatry Program (MCPAP), offers a vital example of the value of this model. Founded in 2004, MCPAP, funded primarily by the Massachusetts Department of Mental Health and in part by major commercial insurance in the state, has facilitated a program to mitigate the state shortage of child mental health professionals for 20 years.
Throughout the program’s history, this goal has been met through a variety of services coordinated through primary care providers (PCPs), including telehealth services for child psychiatry consultations, in-person appointments and overall care coordination. All children and their families in Massachusetts have had free access to the program through their PCPs, regardless of insurance coverage. In recent years, the program has also partnered with the Boston Children’s Hospital Adolescent Substance Use and Addiction Program (ASAP) to address the increasing use of substances in teens.
What Massachusetts and other CPAPs offer is coordinated, specialist-level patient consultation and care management for behavioral health conditions and substance use disorders. By supporting PCPs to communicate with, and refer to, psychiatrists and other behavioral healthcare providers, scarce behavioral health resources are stretched to deliver better care to more people.
In FY2022 alone, MCPAP conducted over 12,000 encounters, including over 7,500 phone consultations and nearly 3,000 face-to-face consultations. In educating PCPs, MCPAP, and other access programs, both support patient care and empower PCPs to continue delivering specialty-level care in the future; studies of the program have shown that 77% of enrolled PCPs feel comfortable treating ADHD, while nearly 70% are comfortable treating depression and anxiety.
Ongoing funding supports access programs
Mental health services are vital to the overall health of our youth now and in the future. As funding for state access programs differs in each state, children and adolescents are at risk of not receiving adequate mental health services.
With an election year upon us, healthcare funding will be a crucial area of deliberation. Recent results from the State of Kids and Families in America 2024 report show that 30% of child and teen respondents identify mental health challenges as the primary concern they face today.
Other data confirm the same challenges among children and youth. The Center for Disease Control and Prevention’s 2021 Youth Risk Behavior Survey results found that 3 in 5 girls felt persistently sad and hopeless. Almost half of LGBTQ student respondents seriously considered attempting suicide, nearly 1 in 4 attempted suicide, and almost 3 in 4 reported persistent feelings of sadness or hopelessness.
In a patchwork system that supports behavioral healthcare across the nation, innovative funding measures like New York’s Medicaid waiver amendment will introduce new opportunities for behavioral health services that cover vulnerable populations: youth, maternal patients and those with SUDs.
Surgeon General Vivek Murthy recently described mental health as “the defining public health crisis of our time.” No crisis can be tackled without the proper tools. As the burden of mental and behavioral illness continues to rise, now is the time to invest in the future well-being of our population.
Photo: SDI Productions, Getty Images
Jesse Schnall, MBBS, MPH, is the Medical Director of Trayt Health and a physician from Melbourne, Australia.
