Report: Medicaid expansion bolsters state’s behavioral health system

A new report from the Montana Healthcare Foundation underscores the important role Medicaid expansion plays in helping improve the state's behavioral health system, including increasing its capacity to prevent and treat certain mental illnesses and substance use disorders.

Year after year, Montana has consistently had one of the highest mortality rates in the nation, which is largely due to drugs, alcohol and suicide — three issues experts say often go hand-in-hand with one another.

Between 2007 and 2018, drug overdoses cost Montana 1,400 lives, the report notes, and 250 Montanans die from suicide annually. In 2020, over 260 individuals died from alcohol-related issues, the highest number in 20 years.

Experts say access to prevention, early intervention, treatment and recovery services would help decrease those figures and improve the overall health and well-being of Montanans. And according to the new report — produced by Manatt Health — the state's Medicaid program, which roughly 100,000 previously uninsured individuals are enrolled in, is instrumental in providing such access.

"Medicaid expansion is fueling an expansion of Montana's prevention and treatment system to address long standing unmet needs, particularly in rural and Tribal communities," said Montana Healthcare Foundation Chief Executive Officer Dr. Aaron Wernham. "This work is just getting started. Turning the tide on addiction, suicide, and mental illness in our state will require steady leadership and dedicated investment for years to come."

A major finding in the report shows that, across the board, more people are accessing behavioral health services.

In 2020, nearly 34,000 Medicaid expansion enrollees, or 37% of the roughly 92,000 individuals in the program, received a behavioral health service or had a behavioral health diagnosis recorded on a claim. Also, between 2019 and 2020, Medicaid expansion enrollee use of behavioral health services increased by 28%, and the use of tele-behavioral health increased by 3,112%.

The sizable bump in telehealth services can be mainly attributed to the COVID-19 pandemic, the report states. In an effort to mitigate the spread of the virus, Montana Medicaid authorized reimbursement for telehealth services at the same rate as in-person visits for nearly all Medicaid benefits in April.

Last year, Logan Health leaders in Kalispell told the Daily Inter Lake that from March to May 2020, providers booked more than 9,000 virtual telehealth visits. That was up from 2,000 virtual sessions performed by the organizations throughout all of the 2019 calendar year.

At the time, Logan Health's Virtual Health Manager said "this [the pandemic] has really been one of the first times where we have been able to witness how important telehealth services are, especially in a rural state and especially during a time like this."

AMONG OTHER things, the 29-page report also highlights the central role primary care plays in identifying behavioral health conditions and connecting people to care.

Between 2016 and 2020, the proportion of Medicaid expansion enrollees who saw a behavioral health provider for the first time within 30-days of a primary care visit increased from 15% to 29%. In addition, nearly 60% of Medicaid patients now receive care in primary-care clinics that also provide behavioral health services, a health-care model known widely as "integrated behavioral health" that has increased in popularity in recent years.

The report states that nine of the state's large hospitals, including Logan Health — formerly known as Kalispell Regional Healthcare — have adopted integrated behavioral health programs. The Agency for Healthcare Research and Quality website states the model essentially strives to blend care into one setting for medical conditions and related behavioral health factors that impact a person's health and well-being.

Other key findings include the following: 8,600 adults participated in psychotherapy in 2020, 3,300 adults received received treatment for substance use disorders in 2020, the number of state-authorized substance use disorder treatment provider service locations more than doubled between 2016 and 2021, and roughly 35% Alaskan Natives/Native Americans that were expansion enrollees in 2020 received a behavioral health service, while 7% received treatment for substance use disorders.

THE STATE expanded Medicaid in 2016, a decision that quickly prompted nearly 40,000 then-uninsured individuals, including nearly 4,000 in Flathead County, to enroll in the program. That number exceeded Montana Department of Public Health and Human Services predictions for first-year enrollees, and according to a dashboard on the agency's website, Medicaid expansion continues to prove beneficial for thousands of Montanans.

As of May of this year, nearly 100,000 individuals were enrolled in the state's program, including nearly 10,000 in Flathead County alone. Since Medicaid expansion's inception, more than 50,000 adults have received outpatient mental health services, and nearly 14,000 have received substance use outpatient services.

Looking forward, the report notes that the new HEART Initiative will allow the state's Medicaid program, which serves as a stable payment source for behavioral health services, to continue to "fill gaps in its care continuum and build a more comprehensive system."

The initiative, which stands for "Healing and Ending Addiction Through Recovery and Treatment," was authorized by the Legislature as part of the 2023 biennium budget. The measure will infuse an additional $25 million annually into Montana's behavioral health system by utilizing state revenue sources and leveraging the federal Medicaid match system.

Reporter Kianna Gardner may be reached at kgardner@dailyinterlake.com.