Oregon’s mental health crisis cannot be blamed on low Medicaid payments for providers, a new study by researchers at Oregon Health & Science University suggested.
Oregon consistently ranks among the worst states for access to mental health services. Yet other states have worse Medicaid payment rates for mental health providers than Oregon, the study found, showing that simply raising rates would not get the state out of the mental health crisis. The study was published Thursday in Health Affairs, a peer-reviewed health policy publication.
State lawmakers in 2022 raised payments starting this year for mental health services provided through the Medicaid-funded Oregon Health Plan. The Oregon Health Plan is responsible for covering the medical care of about 1.5 million low-income Oregonians, including any behavioral health needs they may have.
“We know there are significant barriers in accessing mental health care,” said Dr. Jane Zhu, the study’s lead author and assistant professor of medicine, general internal medicine and geriatrics at OHSU. “States that are chronically underfunding or underpaying their psychiatrists should take note of where they stand. For those states, raising the reimbursement rate may be one tool to increase recruitment and retention of mental health professionals.”
The study looked at billed psychiatric services across the nation and compared the Medicaid payments across different states. It also compared Medicaid payments to those for the same services paid by Medicare, which serves people 65 and older and generally pays more. Oregon is one of just eight states with a Medicaid reimbursement rate that is on par or greater than Medicare for mental health services, the study found.
“Oregon’s not one of the lowest-ranking states,” Zhu said in an interview. “The fees are on a par with that of Medicare, and yet we’re still facing in this state incredible workforce shortages and increased demands and gaps in access, which suggests that there needs to be a lot more in terms of evidence, in terms of how much does a reimbursement rate need to increase in order to induce providers to participate in Medicaid and to see a lot of Medicaid patients.”
On average, Medicaid pays about 80% of what Medicare does for the same services, the study found. States that paid the least were Pennsylvania, Rhode Island and Maine, and those paid the best were Nebraska, Alaska and Arkansas.
Zhu said factors besides reimbursement rates hinder access to care. Those include the administrative burdens providers face, the high demand for mental health services and workforce shortages.
“Reimbursement rates are important, but in Oregon, I think commensurate attention needs to be paid to some of these other factors,” Zhu said.
An OHSU report prepared for the Oregon Health Authority in 2022 found Oregon has the fourth-highest rate nationwide of people unable to access mental health treatment. The state also has one of the highest rates of people with mental health problems, groups like Mental Health America have repeatedly shown in rankings.
The study found that while low wages contribute to the workforce shortage in the sector, other issues like burnout, large caseloads and heavy administrative workloads also harm recruitment and retention into the field.
“Reimbursement rates are just one piece of that puzzle,” Zhu said. “We don’t know whether raising reimbursement rates will be effective in improving access to mental health treatment. Increasing reimbursement rates is probably going to be necessary but not sufficient.”
State lawmakers have introduced a variety of proposals this session to address the state’s mental health crisis, including funding for residential mental health facilities. Gov. Tina Kotek’s plan for behavioral health includes more funding to recruit providers, programs to help people as they are discharged from Oregon State Hospital and community mental health programs to help people avoid jail. The governor also has ordered Oregon behavioral health director Ebony Clarke to complete an assessment on the state’s behavioral health system, which will be the basis of a five-year plan.
Besides Zhu, other co-authors of the study are Stephanie Renfro, associate director of the OHSU Center for Health Systems Effectiveness; Kelsey Watson, biostatistician in the Center for Health Systems Effectiveness; Ashmira Deshmukh, a recent graduate of the OHSU-Portland State University School of Public Health; and John McConnell, director of the Center for Health Systems Effectiveness and professor of emergency medicine in the OHSU School of Medicine.
It appears that the headline and lead paragraph for this article do not match the study. Based on the abstract, this study appears to have only looked at:
1. Psychiatrist reimbursement. Psychiatrists provide just a fraction of Medicaid services.
2. Medicaid "Fee-for-service". Almost all Medicaid services in Oregon are provided through the Coordinated Care Organization structure and not through FFS.
3. Comparison with Medicare. Medicare reimbursement for mental health has been, historically, remarkably low. Access to Medicare mental health care is likely worse than for Medicaid. The comparison should be made with commercial insurance.
Unless there is more information to the contrary, this study does not appear to provide any meaningful insights into Oregon Medicaid mental health services.