Expanding Collaborative Care in Medicaid Can Combat the Country’s Youth Mental Health Crisis
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This article was published by The Commonwealth Fund on November 28, 2022 and is authored by the Meadows Institute’s Melissa Rowan and Kacie Kelly.
Even before the onset of the COVID-19 pandemic, America’s youth were experiencing a mental health crisis. Nearly half of all U.S. teens report that they struggle with persistent feelings of sadness and hopelessness. Eleven percent of young adults ages 16 to 24 and 20 percent of all high school students report serious thoughts of suicide.
Half of mental health conditions present before age 14 and three-quarters — including severe mental illnesses — by age 25, but most are not detected until eight to 10 years after symptoms emerge. Delayed diagnosis often leads to more severe symptoms and suffering, including juvenile justice involvement.
To reverse these trends and meet the behavioral health needs of children and adolescents, early identification and intervention are key. The collaborative care model (CoCM) integrates mental health care into primary care and pediatric settings and has been shown to be effective in the early identification and treatment of mental health conditions. This integration of services addresses access barriers and the stigma often associated with seeking out mental health services.
Despite the proven effectiveness of the model, uptake among Medicaid programs, health systems, and primary care providers has been slow. This delay is based on several factors: not all states have adopted CoCM as a covered benefit under Medicaid, the rates paid for services are insufficient to incentivize provider participation, and the model requires upfront support for practices to ensure successful adoption. Policy changes at the federal and state level could address these factors and accelerate take-up of CoCM in Medicaid, the largest payer of behavioral health care and the largest insurer of children and adolescents, particularly those who are poor and children of color.
Shift the Collaborative Care Model to a Mandated Benefit Under Medicaid
While the Centers for Medicare and Medicaid Services (CMS) authorized paying for CoCM services in 2017, only 22 states have CoCM as a covered Medicaid benefit, although the model is covered under the Medicare program. If CMS required CoCM as a mandated benefit, early identification and treatment would be dramatically improved for millions of children and adolescents on Medicaid.
Make the Collaborative Care Model More Workable for Providers
Streamlining clinical and billing guidelines and raising reimbursement rates could help ensure health system and provider participation in collaborative care models. State Medicaid programs can adopt clinical and billing guidelines consistent with existing Medicare requirements to simplify implementation and billing for providers. State Medicaid authorities also could adopt CoCM rates consistent with Medicare. This would make CoCM more financially viable, increase provider participation, and lead to better access to early identification and treatment services.
Invest in Provider Support to Ensure Successful Adoption
Because CoCM requires changes to clinical workflows and billing practices, upfront investments for implementation along with technical assistance resources are necessary. Policy proposals that expand resources for integrated care infrastructure and encourage widescale adoption are currently being debated in Congress.
At the state level, governors and state legislatures can utilize resources from the American Rescue Plan Act (ARPA) to finance CoCM implementation and technical assistance. For example, Texas is using ARPA funds to aid in the implementation of pediatric-focused CoCM in 18 health systems across the state. Further, state Medicaid authorities can leverage the Affordable Care Act’s Health Homes provision to pay for partial coverage of implementation training and infrastructure costs.
Expanding the adoption and use of CoCM in Medicaid is a critical step to addressing the youth mental health crisis. By making CoCM a mandated benefit under Medicaid, improving its feasibility for providers, and investing in provider and practice support to ensure successful implementation, policymakers could dramatically expand access to the collaborative care model and improve early intervention and treatment for kids.