Medicaid reimbursement rates for most behavioral health and traumatic brain injury services are getting what state health officials are touting as “historic increases” and “transformational.”
The Republican-sponsored state budgets for 2023-24 and 2024-25 include a combined $835 million in one-time and recurring funds for the NC Department of Health and Human Services.
There are currently about 2.3 million North Carolinians as Medicaid recipients. Another 600,000 will be added next year through the Medicaid expansion that officially begins Dec. 1.
This is the first rate increase in more than a decade for most mental health, substance use, and intellectual and developmental disabilities services. The price increases will take effect for services provided on or after January 1.
DHHS called it “the single largest investment in behavioral health by a state legislature.”
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“Old recovery rates are inadequate; meaning that behavioral health practitioners, including psychiatrists, cannot cover the cost of providing care to individuals covered by Medicaid,” said Dr. Carrie Brown, DHHS Chief Psychiatrist.
“This change will help recruit and retain more behavioral health providers, including physicians, psychologists and other licensed professionals such as clinical social workers, in North Carolina’s public behavioral health system.”
Among other things, the funding will increase Medicaid payment levels to 100 percent of Medicare for applicable services, such as outpatient and inpatient behavioral health services.
It also provides inflation-based increases for most enhanced behavioral health services that do not have a Medicare equivalent.
“These rate changes are a lasting and transformative investment in behavioral health services and whole-person care in North Carolina,” said State Health Secretary Cody Kinsley.
“This will improve the foundation of care so that every child and adult can get the mental health and substance use disorder treatment they need, when and where they need it.”
Total reimbursement for inpatient behavioral health services is expected to increase by 30%, while psychiatric diagnostic evaluation will nearly double from the previous rate.
Additional information about these increases will be shared through a Medicaid provider newsletter.
Nationwide need
DHHS said the behavioral health crisis affects everyone in the state, with one in four children and one in five adults experiencing a mental health need.
“Rates of anxiety and depression have risen sharply in recent years, and care providers have been pressured to keep up,” DHHS said.
DHHS said there are dozens of counties in North Carolina that lack a psychiatrist. Every day in North Carolina, more than 300 adults and children wait in emergency rooms for a behavioral health care bed.
“For many, the introduction to behavioral health care is through the crisis system and hospital emergency rooms,” said Kelly Crosby, director of the state Division of Mental Health, Developmental Disabilities and Substance Use Services.
“We need to improve access to routine mental health care and substance use treatment in every North Carolina community so that services are available when people need them.”
Rate funding for diagnostic evaluations and developmental/psychological testing and assessment will also be increased above the Medicare rate, pending approval by the federal Centers for Medicare and Medicaid Services.
The 2023-2025 budget also allows for significant investment in alternatives to the emergency department, such as facility-based crisis services, and investment in direct support professionals, including peer support professionals.
Answers
The increase in recovery rates will help offset some of the additional operating costs affecting behavioral health providers, said Billy West, CEO of DayMark Recovery Services, a provider of behavioral health services in the Triad and statewide.
Still, West said that while “some really positive things have happened like the Medicaid expansion, there are also some real issues that are rearing their heads as well.”
West cited as an example that there are different rates for providers offering services through the planned personalized plan format, state funding for a plan for the poor and for prepaid health plans.
“They all cover Medicaid, all different,” West said. “They all have variations of different rules, rates and so on. It’s not so much that they’re all bad as that they’re all different.”
West said the reimbursement rate increase does not cover private insurance “or the ever-growing number of Accountable Care Act plans.
“ACA plans are terrible for behavioral health providers in general. They get people who are 300% of the poverty level to sign up for basic free. That’s good, these people already have plans that will cover them if they have a serious illness.
“But to see a provider like us, well, they have to pay the first $5,000 or even more before the plan pays anything. If they are 300% of the poverty level, how are they going to pay anything? Shall we repel them?’
West also cited that crisis services, such as behavioral health emergency and facility-based crises, may pay different rates.
“Whatever the current or future benefits of Medicaid payer privatization, it has not come without significant growth constraints and increased overhead costs for ratepayer providers that are not built into our work to perfect this new system.” “
The increased reimbursement rates could serve as an incentive for more providers to accept or begin serving more Medicaid recipients, said local behavioral health advocate Lori Coker.
Coker is president of the advocacy group NC CANSO and head of GreenTree, a community-based crisis support group offered by partners. She also served on the board of CenterPoint Human Services, a former behavioral health care organization serving Forsyth County.
“It’s certainly time to increase reimbursement levels for publicly funded mental health services, and the shortage of practitioners really shows that,” Coker said.
“If we want public funds to lead to better mental health, we also need to review the services now offered through our state system for their impact.”
“We also need to focus on funding processes — using Medicaid or other sources like the Mental Health Grant — that fund facilitating access to treatment and other resources according to the social determinants of health.”
Coker said it remains unnecessarily complicated and challenging to access mental health services locally and across the country.
“Those who may need treatment often face the greatest barriers to seeking help,” Coker said.
“If we want to improve the outcomes of the Medicaid system, we need flexibly funded partner services that serve as a support fabric for fairly leaky security systems.”
