While campaigning for Congress and serving in the Oregon Legislature, then-state Rep. Andrea Salinas recalled hearing from seniors about how their Medicare plans didn’t always cover mental or behavioral health services.
Now serving her first term in Congress, Salinas is introducing legislation intended to make behavioral health services more available to people covered by the federal government’s two largest insurance programs.
If passed, Salinas’ bill would require both Medicaid and Medicare to cover without cost shares three primary care visits for recipients that’ll include outpatient behavioral health services.
The Lake Oswego Democrat’s bill comes as Oregon and the rest of the country grapple with the prevalence of mental health and substance use disorders. Salinas told The Lund Report that even if her bill passes, there’s still a national shortage of behavioral health providers. But she said that too many people covered by Medicare or Medicaid, the federal government’s respective programs for the elderly and low-income people, don’t seek care because it’s either too expensive or they think it will be.
“Let’s start getting people used to the idea,” she said. “I think it reduces stigma, especially for older Americans who maybe have never really thought about why it is that they’re maybe clinically depressed, why it is that they’re relying on substances to heal their pain.”
Salinas said that many older adults have issues with income and housing insecurity and they tend to be at greater risk for suicidal ideation and self-harm.
People covered by Medicaid and Medicare face particular challenges in finding behavioral health providers because of the low reimbursement rates for both programs, according to the Commonwealth Fund.
A 2020 study found that efforts to decrease cost-sharing Medicare beneficiaries for outpatient behavioral health care services didn’t result in more access. The study found that about a quarter of Medicare beneficiaries have a mental illness, with only about half of the affected receiving treatment.
Congress in 2008 passed the Mental Health Parity and Addiction Equity Act that requires private insurers to treat mental health and physical conditions the same. However, the law doesn’t apply to Medicare or Medicaid.
“We have this sort of prevention mindset on the medical side that allows these visits with a medical provider,” Chris Bouneff, the executive director Oregon chapter of the National Alliance on Mental Illness, told The Lund Report. “You don't typically have that on the mental health side universally.”
Bouneff said that currently the health care system is built around people with a behavioral health challenge contacting a provider. He said making the system more geared toward prevention could be “really impactful” if it can develop a standardized way of screening people for conditions that could worsen if untreated.
The Oregon Health Plan, the state’s version of Medicaid, covers behavioral health services for recipients
“Our most vulnerable population can go to a mental health provider and get care without paying a copay,” Julie Ibrahim, CEO of Tigard-based mental health service provider New Narrative, told The Lund Report. She praised Salinas for trying to make behavioral health services more available to Medicaid recipients in other states.
But the National Institute for Health Care Management published figures in June showing that half of Americans already live in an area with a mental health workforce shortage.
Oregonians covered by the federal programs also face this — and the low reimbursement rate — problems. Just under a third of Oregonians’ mental health care needs are currently being met, according to figures from the think tank KFF.
A 2022 study found that in Oregon, more than half of mental health providers listed in Medicaid network directories were “phantom” providers that didn’t actually treat patients covered by the low-income health program.
Salinas acknowledged that Oregon still doesn’t have all the treatment facilities it needs, which she said is a barrier.
But Salinas said the bill isn’t just about getting more services to people, but also understanding the level of need.
“Once we start to have people come from out of the woodwork and raise their hands and say, ‘Yes, I want care,’ then we can actually start to define: What does success look like then, from a provider standpoint?” she said.