On June 30, the U.S. Government Accountability Office (GAO) released a report examining children’s access to health coverage under Medicaid and the Children’s Health Insurance Program (CHIP).  The GAO studied physicians’ willingness to care for children enrolled in the programs and physicians’ willingness to accept new children insured through them.  The authors also examined the difficulty physicians face in referring children enrolled in Medicaid and CHIP to specialty care.  The report found that 83 percent of primary care physicians and 71 percent of specialty physicians serve children enrolled in Medicaid and CHIP.  Among physicians participating in the government programs, the authors found that 79 percent are accepting new privately insured children while only 47 percent are accepting children enrolled in Medicaid or CHIP.  The report also found that non-participating physicians most commonly cite administrative issues as barriers to participation, including low and delayed reimbursements.  The GAO concluded that physicians face significant difficulty in referring Medicaid and CHIP-enrolled children to specialty care, including mental health.

From the report:

On March 15, the Medicaid and CHIP Payment and Access Commission (MACPAC) presented its first annual Report to the Congress on Medicaid and CHIP.  The report found that Medicaid covered 68 million individuals in FY2010, with state and federal spending totaling $406 billion, or 8.1 percent of federal outlays.  In addition, MACPAC determined that the Children’s Health Insurance Program (CHIP) covered 8 million children in FY2010 at a total cost of $11 billion.  Finally, the report also notes that the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) determined that Medicaid financed 25 percent of behavioral health treatment in 2003.

From the report:

Medicaid and CHIP’s impact is far-reaching, affecting the people they serve, the providers they pay, and the federal and state budgets that fund them. Medicaid is the foundation of the nation’s health care safety net, representing a shared federal and state commitment to serving the health needs of low-income families, seniors, and persons with disabilities. Many of the children enrolled in CHIP are from working families who cannot afford insurance coverage or whose employers do not offer health benefits. Like other payers, Medicaid and CHIP operate in a changing health care environment. The joint federal and state programs have undergone significant changes since their enactment, particularly with respect to size, scope, and cost. Today, Medicaid is a $406 billion program that finances health care for 68 million people and CHIP is an $11 billion program that finances health care coverage for 8 million children. The federal government’s share of Medicaid program costs is $274 billion and its share of CHIP costs is $8 billion.

Full report: Report to the Congress on Medicaid and CHIP

Medicaid and CHIP Payment and Access Commission.  (2011).  Report to the Congress on Medicaid and CHIP.

On April 21, the Kaiser Family Foundation released a brief offering an overview of the U.S. behavioral health system, outlining the sources of behavioral health financing, and discussing the relationships between payers.  Noting that Medicaid pays for 25 percent of all behavioral health expenditures, the brief focuses on Medicaid’s role in financing behavioral health services.  The brief claims that, although service utilization has increased, both insured and uninsured individuals continue to have unmet treatment needs.  The brief notes that over 60 percent of adults with a diagnosable mental health disorder do not obtain treatment while nearly 90 percent adults with a substance use or dependence disorder did not receive specialty treatment.  The brief concludes that policymakers must consider the behavioral health financing system when determining how to reform the national health care system.

From the report:

The behavioral health care system to provide mental health and substance abuse services in the United States is financed through multiple sources. These include states and counties, the federal-state Medicaid program, the federal Medicare program, private insurance coverage, patients’ out-of-pocket expenditures, and a host of smaller public and private programs. The various funding sources form a complex patchwork of programs, each with particular eligibility rules and benefits packages. The complexity of the system challenges policymakers’ ability to undertake reform in mental health policy. This primer provides an overview of behavioral health care, reviews the sources of financing for such care, assesses the interaction between different payers, and highlights recent policy debates in mental health.

Full report:  Mental Health Financing in the United States: A Primer (PDF | 2.41 MB)

Kaiser Family Foundation.  (2011).  Mental health financing in the United States: a primer.  Garfield, R.

This report published in Psychiatric Services reviewed the recently implemented reimbursement policies for screening and brief intervention for substance misuse by Medicaid, finding that though many states allow the reimbursement of this service, current policy is not sufficient at promoting high utiltization.

Fussell, H. E., Rieckmann, T.R., and Quick M.B. Medicaid reimbursement for screening and brief intervention for substance misuse.  Psychiatric Services, 62: 306-309. doi: 10.1176/appi.ps.62.3.306. http://psychservices.psychiatryonline.org/cgi/content/abstract/62/3/306

Authors: Holly E. Fussell, Traci R. Rieckmann, and Mary Beth Quick

This report published in Psychiatric Services analyzed spending on mental health and substance use disorder treatment in the Department of Veterans Affairs, finding that from 2000 to 2006 costs decreased each year. However, in 2007, the agency experienced a large increase in spending.

Wagner, T. H., Sinnott, P. and Siroka, A. M.  Mental health and substance use disorder spending in the Department of Veterans Affairs. Psychiatric Services, 62:389-395. doi: 10.1176/appi.ps.62.4.389. http://psychservices.psychiatryonline.org/cgi/content/abstract/62/4/389

Authors: Todd H. Wagner, Patricia Sinnott, and Andrew M. Siroka

On March 15, the Medicaid and CHIP Payment and Access Commission (MACPAC) presented its first annual Report to the Congress on Medicaid and CHIP.  The report found that Medicaid covered 68 million individuals in FY2010, with state and federal spending totaling $406 billion, or 8.1 percent of federal outlays.  In addition, MACPAC determined that the Children’s Health Insurance Program (CHIP) covered 8 million children in FY2010 at a total cost of $11 billion.  Finally, the report also notes that the  Substance Abuse and Mental Health Services Administration (SAMHSA) determined that Medicaid financed 25 percent of behavioral health treatment in 2003.

From the report:

Medicaid and the State Children’s Health Insurance Program (CHIP) are sources of health care coverage for 76 million people, almost one quarter of the population. Medicaid finances health care and related services for more than 30 million low-income children, more than 10 million low-income persons with disabilities, and 6 million low- income seniors with Medicare. CHIP finances health coverage for 8 million uninsured children in families with moderate incomes above Medicaid eligibility levels.

This is the first report of the Medicaid and CHIP Payment and Access Commission (MACPAC) to the Congress. The purpose of this initial report is to contribute to a better understanding of the Medicaid and CHIP programs, their roles in the U.S. health care system, and the key policy and data issues to be addressed. This first report also sets out an analytic framework that serves as the foundation for the Commission’s future work with respect to access and payment. Also included in the Report is a compilation of Medicaid and CHIP program information, including state-specific information about program enrollment, spending, eligibility levels, Medicaid benefits covered, and the federal medical assistance percentage (FMAP). This section of the Report, called MACStats, will be a standing supplement in all Commission reports to the Congress.

Full Report: MACPAC: Report to the Congress on Medicaid and CHIP 

Medicaid and CHIP Payment and Access Commission. (2011). Report to the Congress on Medicaid and CHIP.