Tag: news

Understanding the U.S. Behavioral Health Workforce Shortage

Nearly half of all Americans will have a behavioral health issue in their lifetime, from a mood disorder to a substance use problem. Behavioral health care encompasses a wide variety of interventions delivered by many different types of providers. In the U.S., nearly all these providers are in short supply.

The scarcity of behavioral health professionals is undermining people’s ability to get timely care. This is reinforced by historical underinvestment in behavioral health care by public insurance programs (like Medicaid and Medicare), private insurers, and employers — including lack of coverage and low reimbursement rates. In 2021, fewer than half of people with a mental illness were able to access timely care; those with substance use disorders were even less likely. Some groups are disproportionately impacted by workforce shortages:

  • Many rural areas and economically stressed cities have few, if any, behavioral health care providers. For example, in 2018, more than half of the counties in the U.S. did not have a practicing psychiatrist. One study found that counties outside of metropolitan areas had one-third the supply of psychiatrists and half the supply of psychologists as their more urban counterparts. As of March 2023, 160 million Americans live in areas with mental health professional shortages, with over 8,000 more professionals needed to ensure an adequate supply.
  • People covered by Medicaid and, to a lesser extent, Medicare struggle to find providers that accept their insurance, in large part because of low reimbursement rates, particularly in Medicaid. One study found that in Oregon, more than half of the mental health providers listed in network directories of Medicaid managed care plans did not actually see Medicaid enrollees. This has profound implications for equitable access, as Medicaid is the nation’s largest payer of behavioral health services.
  • Underserved groups like people of color, non-English speakers, and LGBTQ communities often struggle to find appropriate services. As is the case with many other health care specialties, the demographics of the behavioral health workforce often do not reflect those of the people they serve. For example, while nearly one-third of the U.S. population is Black or Hispanic, only about a tenth of practicing psychiatrists come from these communities. This mismatch limits the ability of people to get culturally and linguistically appropriate care.

To better understand these shortages, we need to know who makes up the behavioral health workforce and the challenges they face in providing care to underserved communities.

Read the full article from the Commonwealth Fund.

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‘A System in Crisis’: Dysfunctional Federal Disability Programs Force the Poor to Pass Up Money

Brenda Powell had suffered a stroke and was in debilitating pain when she called the Social Security Administration last year to seek disability benefits.

The former Louisiana state office worker struggled at times to write her name or carry a glass of water. Powell, then 62, believed she could no longer work, and she was worried about how to pay for medical care with only a $433 monthly pension.

Although the Social Security Administration agreed that Powell’s condition limited the work she could do, the agency rejected her initial application for Supplemental Security Income. She had the choice to appeal that decision, which could take months or years to resolve, or take early retirement. The latter option would give her $302 a month now but might permanently reduce the full Social Security retirement payment she would be eligible for at age 66 and 10 months.

“I didn’t know what to do. These decisions are not easy,” said Powell, who lives in Alexandria, Louisiana, about 200 miles northwest of New Orleans. She decided to appeal the decision but take early retirement in the meantime.

“I had to have more money to pay my bills,” she said. “I had nothing left over for gas.”

Every year, tens of thousands of people who are disabled and unable to work consider taking early retirement benefits from Social Security. The underfunded federal disability system acknowledges that it is stymied by delays and dysfunction, even as over 1 million people await a decision on their benefits application.

The United States, which has one of the least generous disability programs among developed Western nations, denies most initial claims, leaving applicants to endure a lengthy appeals process.

At the same time, Social Security agents may neglect to explain the financial downside of taking retirement benefits too early, said attorneys who help patients file disability claims. The result is a growing population of vulnerable people who feel stuck between a proverbial rock and a hard place — to live with little money while they wait it out or agree to a significantly lower payment for the rest of their lives.

“They don’t have the luxury of waiting,” said Charles T. Hall, a disability attorney based in Raleigh, North Carolina. “The vast majority of people need the money now, and you can get early retirement benefits in two months or less.”

In a nation where more than a quarter of residents have a disability, Social Security Disability Insurance and Supplemental Security Income programs are intended to provide financial help to people who cannot work.

Read the full article from KFF.

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Apple Health (Medicaid) Renewal Letters Have Begun Mailing

Some clients will automatically renew; and others will need to update their information

OLYMPIA – The Washington State Health Care Authority (HCA), Washington Health Benefit Exchange (Exchange), and the Department of Social and Health Services (DSHS) have begun mailing letters to Washington Apple Health (Medicaid) clients reminding them to update their contact information and renew coverage to see if they still qualify.

For the first time in over three years, people on Apple Health could lose coverage if their family income has gone up. Federal requirements during the COVID-19 public health emergency (PHE) led to income checks being suspended to keep clients enrolled in Apple Health during the pandemic. However, last December’s federal omnibus spending bill directed states to resume evaluating eligibility of Medicaid enrollees on April 1 to wind down COVID-19 pandemic emergency measures.

Washington has until April 2024 to process eligibility redeterminations for all 2.3 million Apple Health clients. It’s the largest benefit renewal process the state has ever attempted. Here is what you need to know during this effort.

How the renewal process works

Washingtonians on Apple Health will get their renewal notifications at different times. To manage the workload, the renewals are being spread out over the next 12 months.

Some clients will be automatically renewed based on the most recent information already on file with the state. If the state does not have enough information on file, clients will need to take action to complete the renewal process to stay insured.  

  • If clients are auto renewed, they will get a notification saying their health coverage was renewed. For most, health coverage will be renewed for 12 months. The requirement will continue for clients to report any changes within 30 days.
  • If clients are not auto renewed, they will get a renewal notice in the mail. They must respond to complete their renewal by the 60-day deadline. If at the end of 60 days the client hasn’t responded, the state will send a notice informing them their Apple Health benefits are ending.

How to know when it’s time to renew

Your renewal month typically matches the month your Apple Health coverage started. Clients can check their most recent Apple Health notice to confirm their renewal date. The month before their renewal date, clients will receive a notice about their Apple Health renewal. For example, if a client’s coverage is up for renewal on May 31, 2023, they should act now to avoid a loss in coverage.

Starting April 2023 through March 2024, HCA and DSHS will evaluate current Apple Health client eligibility for continued coverage and renew or terminate coverage as appropriate.

What steps do clients need to take?

We encourage Apple Health clients to take the following steps:

  • Update their contact information as soon as possible.
  • Check their mail or email. Starting in April and through March 2024, clients will receive information about their Apple Health coverage via mail or email. This notification may require them to take action in order to maintain coverage.
  • Complete their renewal by the deadline on their notice.

“It’s imperative that Washingtonians enrolled in Apple Health take time to update their contact information to ensure they receive upcoming notices related to their health care coverage,” said Sue Birch, HCA director. “If people learn they are no longer eligible for Apple Health, there are other options for low-cost health coverage.”

“We know how important it is to have access to health care when we need it most, and we are committed to making sure people stay connected to this vital benefit,” said Jilma Meneses, DSHS secretary. “We are ready to answer any questions or concerns people might have, and to provide as seamless a process as possible.”

“We want to ensure all Washingtonians stay covered, whether it is Apple Health, employer sponsored, or a new qualified health plan,” said Ingrid Ulrey, CEO at Washington Health Benefit Exchange powering Washington Healthplanfinder. “If you receive a letter from HCA, Washington Healthplanfinder, or DSHS, make sure you open it, and visit Healthplanfinder right away so we can help you with your insurance needs. For those who are now above income eligibility, they will have the opportunity to enroll in high-value, low-cost Cascade Care Plans, now available for as low as $10 or less per month.”

To help Washingtonians transition to other health insurance, HCA has partnered with DSHS and Washington Healthplanfinder to connect people to other coverage. To ensure clients receive important notices about their health care coverage, including other coverage options, Apple Health clients can update their contact information using one of the following options:

  • For individuals who are aged, have blindness or a disability, or are eligible for Medicare:
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Proposed Work Requirements Could End Federal Medicaid Coverage for 1.7 Million People

A new KFF analysis finds that an estimated 1.7 million Medicaid enrollees could become ineligible for federal Medicaid under proposed work requirements and presents state-by-state projections, based on estimates of coverage loss from the Congressional Budget Office (CBO). 

States could continue to provide Medicaid to those enrollees but would not receive federal matching funds for doing so. It is unclear if any states would choose to do that, though CBO estimated over half of enrollees would continue to be covered at the states’ expense. If states did choose to continue coverage for those individuals, states collectively could face $10.3 billion in new costs in 2024. 

The work requirements were included in the Republican-backed debt ceiling legislation that passed the House of Representatives on April 26.

Five states would pay nearly half of the estimated $10.3 billion in new costs: California (326,000 enrollees at a cost of $1.6 billion), New York (186,000, $1.1 billion), Illinois (116,000, $692 million), Pennsylvania (83,000, $537 million) and Washington (72,000, $578 million).

Read the full article from KFF.

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Your Apple Health: What you need to know about the Public Health Emergency

During the Covid-19 Public Health Emergency, Washington State changed some rules about Apple Health (Medicaid). If you or a family member had Medicaid for health insurance, you did not have to renew every year. If you paid a premium for Medicaid health insurance, premium payments stopped during the Public Health Emergency. Some people received temporary health insurance coverage if they qualified for other benefits.

The PHE ended March 31, 2023, and now:

  • Beginning April 2023, you must renew your Apple Health/Medicaid insurance
  • If you usually paid a premium, premiums are starting up again
  • You may need a new eligibility review

If you do not renew, do not complete a required eligibility review or if you do not pay a premium when it is due, you may lose your health insurance coverage for you or your family member.

What to do:

  • Update your contact information with your insurance provider so your provider can send you important information about renewal, eligibility reviews and premiums
  • Renew your insurance when your provider tells you
  • Premiums for certain Apple Health/Medicaid insurance plans are starting again (Apple Health for Kids with premiums/Children’s Health Insurance Program, Apple Health for Workers with Disabilities (HWD). Watch your mail or email for notices or premium bills from your provider

If you are on one of these Apple Health/Medicaid plans, call:

  • Amerigroup: 1-800-600-4441
  • Community Health Plan of Washington: 1-800-440-1561
  • Coordinated Care: 1-877-644-4613
  • Molina:1-800-869-7165
  • UnitedHealthcare: 1-877-542-8997

If you usually get notices from WA State Health Care Authority email askmedicaid@hca.wa.gov with your name, date of birth, and updated contact information.

If you usually get notices from Washington Healthplanfinder:

  • Log in to your Washington Healthplanfinder account at wahealthplanfinder.org
  • Call Washington Healthplanfinder at 1-855-923-4633

If you are age 65 and older, have blindness or a disability, get Medicare, and get healthcare coverage through Department of Social and Health Services (DSHS):

  • Update contact information at waconnection.org or call 1-877-501-2233 or
  • Visit your local Community Service Office
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Q&A: Implications of the Ruling on the ACA’s Preventive Services Requirement

Note: This post was updated on April 4, 2023, to include additional details and a table showing potentially affected preventive services.

On March 30, 2023, a judge in the U.S. District Court in the Northern District of Texas issued a final judgment in a court case challenging the provision of the Affordable Care Act (ACA) that requires most private health plans to cover a range of preventive services without any cost-sharing for their enrollees. Having concluded in September that aspects of the requirement were unconstitutional and violated religious rights, the judge’s remedy in the Braidwood Management v. Becerra imposes new limits on the government’s ability to enforce those requirements nationwide. This Q&A summarizes some of the key issues related to the ruling.

What does the ruling mean for the public?

With about 100 million privately insured people using preventive services required by the ACA to be covered without out-of-pocket costs, the preventive services coverage requirement is the provision of the ACA that affects the broadest number of people, and it has been enormously popular with the public. Because of the ACA requirement, the vast majority of private health plans have to cover a range of preventive services and cannot impose deductibles or copays for them. If the ruling stands, over time, millions of people could end up paying more for preventive care and some may lose access to certain services. However, as sweeping as the ruling is, it does not completely and immediately wipe out preventive services coverage under the ACA.

That’s because the ruling applies specifically to services recommended by the US Preventive Services Taskforce (USPSTF) that were made after 2010 when the ACA was enacted. The ruling would not overturn coverage requirements for vaccines recommended by the Advisory Committee on Immunization Practices (ACIP), women’s preventive health services (such as contraception, well women care and prenatal care, breastfeeding support services, and intimate partner violence screening) recommended by the Health Resources and Services Administration (HRSA),  or services for children and young adults recommended by Bright Futures, though the plaintiffs had asked that those be struck down as well and that decision could be appealed. The ruling also only applies to updates to or new USPSTF recommendations issued since March 2010, when the ACA was enacted. It would effectively lock in place coverage requirements based on evidence from 13 years ago.

The ruling separately finds that the mandate to cover pre-exposure prophylaxis (PrEP), a medication taken to prevent HIV, violates the plaintiffs’ religious rights under the Religious Freedom Restoration Act (RFRA). While the RFRA remedy is limited specifically to the plaintiffs, because PrEP was recommended by the USPSTF after 2010, the medication and certain ancillary lab services can now be subject to out-of-pocket costs across all health plans and plans could elect to drop coverage altogether.

Coverage will not necessarily change immediately. Although the ruling is effective immediately, in many cases, health plan contracts are in place for the calendar year, and employers do not typically make changes to coverage or cost midyear. (It may be easier for plans to change formularies to allow for cost-sharing with respect to impacted drugs.)

Read the full article with details about changes at KFF.

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Quick Guide to Recent Changes to Medicare

The Consolidated Appropriations Act (CAA) and the Inflation Reduction Act (IRA) improve program benefits, clarify enrollment rules, eliminate coverage gaps, and strengthen the program for the estimated 64.5 million Americans who have Medicare health care coverage. These changes to Medicare provide important protections and strengthen the program, but navigating the changes can be complicated. To help the aging and disability networks who are fielding questions and making sure that the people they serve are aware of these changes, this blog post provides an overview of the changes that are most important for older adults and people with disabilities to be aware of. For people who need additional help, ACL’s State Health Insurance Assistance Program (SHIP) offers one-on-one assistance, counseling, and education to Medicare beneficiaries, their families, and caregivers to help them make informed decisions about their care and benefits.

CAA Medicare Provisions

The CAA revised key Medicare enrollment rules and timelines for coverage to become effective. It also extended limited eligibility to cover immunosuppressive drugs for kidney transplant patients under age 65.

Key Medicare Enrollment Rules

Most people (88%) qualify for Medicare when they celebrate their 65th birthday. The remaining 12% qualify due to disability.

Most people who qualify based on age need to enroll in Medicare when they turn 65, even if they have other health insurance. People can defer enrollment in a few situations. For example, if they (or their spouse) are still working for an employer that has 20 or more employees and have health insurance through that employer, they can wait to enroll in Medicare until they are not.

People who do not apply when they are first eligible usually have to wait until the next open enrollment period to get coverage. In addition, most will have to pay higher premiums — forever — if they enroll late.

People who receive Social Security retirement or disability benefits (or Railroad Retirement benefits) are automatically enrolled in Medicare when they become eligible, but everyone else needs to apply. Unfortunately, many people do not understand this, or mistakenly believe they qualify for delayed enrollment, and they do not enroll when they should.

Read the full article from the Administration for Community Living.

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Executive Order Expands Access to Community Living Services, Supports Family Caregivers

On April 18, 2023, President Biden will sign an executive order (EO) that includes more than 50 directives to federal agencies to increase access to affordable, high-quality care, and provide support for care workers and family caregivers.

The EO directs actions to improve job quality for the professionals who provide the critical services that make community living possible for millions of people. It includes actions to improve support for the 53 million family caregivers who provide the overwhelming majority of long-term support to older adults and people with disabilities. It also directs actions to expand availability of home and community-based services, including those funded by Medicaid and the Department of Veterans Affairs.

This exciting EO creates new momentum for ACL’s work to strengthen the care infrastructure that helps people with disabilities and older adults live and fully participate in their communities, including our work leading the National Strategy to Support Family Caregivers and to strengthen and expand the direct care workforce, our partnership with the Veterans Health Administration on the Veteran-Directed Care program, and more.

This White House fact sheet has more of the highlights. (We will share a link to the full text of the EO on our social channels and on ACL.gov as soon as it is available.)

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Medicare Advantage Special Needs Plans for dual eligible (Medicare and Medicaid) clients

Medicare Advantage Special Needs Plans are available to clients who are eligible for Medicare and Medicaid (dual eligible). Special Needs Plans provide additional benefits to clients beyond what traditional Medicare and Medicaid provide including, but not limited to, care coordination, gym memberships, transportation to medical appointments and meal delivery.

Click the below link to learn more.

dual-eligible-special-needs-plan

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Teen Health Crisis

Adolescent Mental Health & Wellbeing

A new CDC report points to record levels of violence, trauma, and mental health concerns for teenagers, with girls and LGBQ+ youth faring more poorly (the survey did not ask about transgender identity). The findings highlight how the pandemic made things worse for many kids.

  • Violence: Violence puts adolescent lives at risk and can lead to mental health problems, risky behavior, and reduced academic success. The CDC report contains data on violence among high schoolers, including sexual violence, feeling unsafe at school, bullying, and cyberbullying.
  • Technology: High use of social media is associated with mental health problems. Social media impacts how teens interact with one another during a developmentally important time in life. According to new research, limiting social media usage can make teens feel better about their body image.
  • Supporting Mental Health: Young people who identify as LGBTQ+ are less likely to feel depressed with parental support. Additionally, public schools and states are taking steps to expand access to mental health services.

Read more at NIHCM.

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