Study finds unequal reimbursement rates in CT’s mental healthcare
Late last year, the Office of Health Strategy (OHS), outlined payment parity issues with Connecticut’s mental healthcare, noting Medicaid reimbursement rates are much lower than commercial insurance rates. As a result, providers are typically underpaid, and unsurprisingly, fewer will accept that plan.
OHS, working in conjunction with the Department of Children and Families, Mental Health and Addiction Services, and Social Services, published a report detailing the findings of a study done to assess the factors impacting the accessibility of behavioral healthcare
The study found that HUSKY, Connecticut’s Medicaid, had comparatively lower reimbursements rates in 2022 compared to other New England states.
Also, Connecticut had fewer behavioral healthcare providers, many of whom did not participate in Medicaid. Instead, they were more likely to be in-network with commercial insurance plans. And of those providers, there were fewer psychologists and social workers compared to Massachusetts and Vermont.
“The findings identify opportunities to improve parity between Medicaid (HUSKY) and commercial insurance and to improve parity between medical and behavioral health services in commercial and Medicare Advantage plans,” said OHS Commissioner Deidre Gifford, MD, MPH, in an email.
“Our state Medicaid authority, the Department of Social Services, increased some behavioral health reimbursement rates even before the study was published to reduce barriers to access,” she added.
Mary Giliberti, Mental Health America’s chief public policy officer, wrote in an article that a psychiatrist could make more than double seeing a patient by billing them directly than if that patient was covered by Medicare and three times as much if they had Medicaid.
Giliberti also cited a Government Accountability Office report that showed one of the main reasons patients lack access to appropriate care is the inadequate reimbursement rates.
She called Medicaid “the most broken of health insurance programs,” in relation to reimbursement rate setting.
“ Data demonstrates that Medicaid programs in most states pay less than Medicare, with some states paying less than half of Medicare reimbursement rates for primary and maternity care.”
Connecticut, however, is not the worst state when it comes to mental healthcare coverage. According to published reports, the worst states are primarily in the South with Texas topping the list.
Within the top 10, four of the New England states—Vermont, Connecticut, Rhode Island, and Massachusetts, respectively—made the cut. Even so, there is room for improvement when it comes to getting patients the care they need.
“Although Connecticut has one of the lower uninsured rates in the country at 5.2 percent (3.2 percent for youth under 19) we, like all states, have more work to do to ensure healthcare affordability and address disparities in access to care,” Gifford said.
She noted the state has been a leader in prioritizing behavioral health payment parity and bases its policy initiatives on data-driven strategies.
On its website, New York-based Commonwealth Fund posted an article saying Medicaid’s reimbursement rate goes beyond a lack of coverage—it is also about racial justice.
Medicaid’s notably low reimbursement rates often mean providers spend more on the care for those recipients without getting comparable payment. Underpayment was estimated at $24.8 billion. That underpayment limits access to quality care and leads to poor health outcomes for those recipients, who are largely people of color.
Gifford said research shows that reimbursement rates, administrative burdens, and health professional shortages are factors that influence provider access in communities and can have a “disproportionate impact,” on resource limited communities and communities of color.
“Assessing the disparity of participation in HUSKY in some professional disciplines as compared to commercial insurers, helps us to prioritize policy or reimbursement changes to address identified equity issues and measure the impact of those changes to ensure we’re making progress,” she said.
Since the initial pandemic lockdown, mental health has taken a huge hit. Approximately one in five adults experienced a mental health disorder in 2021. Nearly half a million residents 12 and older had a substance use disorder that same year.
Drug overdoses have also been on the rise and as of June 2023, a little over 1.5 million residents lived in a region of the state with mental healthcare workforce shortages.