Only 8% of Medicaid and 4% of Medicare Enrollees Received Behavioral Health Services

New government findings outlined in a recently issued report add details to the lack of availability of behavioral health services for America’s poor and elderly.

The Office of Inspector General (OIG) for the U.S. Health and Human Services Department found that about one-third of behavioral health providers in selected counties serve patients in the Medicare, Medicare Advantage, or Medicaid programs.

The report focuses behavioral health services offered during 2021 -- a time before significant action was taken by the agency that oversees the three programs, the Centers for Medicare & Medicaid Services (CMS), along with the White House and Congress.

Medicare spends an estimated $27 billion a year on behavioral health services, while about 1-in-4 members are coping with a behavioral health condition. For Medicaid, the cumulative spending totals about $52 billion, while adult members experience mental health conditions at a rate of 29% and substance use disorders (SUD) at about 21%, the report states. Some of the causes of the shortage are well-known in the industry: the administrative burden of participating in certain health plans (especially the prior authorization and credentialing processes), low payment rates by payers and overall provider shortages.