Opting Out of Medicaid Expansion: Impacts on Behavioral Health Services at Community Health Centers

ARLINGTON, Va. — A cost analysis of states’ decisions to opt out of Medicaid expansion under the Affordable Care Act shows these states will receive less revenue and have a reduced capacity to serve people with mental illness. If all 50 states expanded Medicaid by 2020, an additional 70,500 behavioral health services would be provided that year. The study is published online today in Psychiatric Services in Advance.

The study focused on community health centers, a key source of medical and behavioral health services in underserved communities because they serve all patients regardless of the ability to pay. Health centers are not required to provide behavioral health services, making these services vulnerable to cuts if there is not enough funding. Most health center patients have incomes below the federal poverty line; centers in states that have expanded Medicaid are likely to see increased revenue as more patients will have health insurance to cover the cost of their care, according to study authors.

The authors calculated that, if all 50 states expanded Medicaid by 2020, health centers would accrue nearly $230 million in additional revenue during that year, because fewer of their patients would be uninsured. Based on previous health center spending, the study found this would likely provide an estimated $11.3 million for mental health services and $1.6 million for substance use disorder services in 2020, resulting in more than 70,500 additional encounters with behavioral health specialists.

The authors, led by Emily Jones, Ph.D., M.P.P., with the U.S. Department of Health and Human Services and the George Washington University, conclude that onsite mental health services are necessary at community health centers and that the financial consequences of opting out of Medicaid will limit the ability to provide these services in states that opt out. The study also highlights an important indirect benefit of Medicaid expansion — that expanding Medicaid would likely result in higher utilization of behavioral health services in health centers.

The American Psychiatric Association is a national medical specialty society whose more than 36,000 physician members specialize in the diagnosis, treatment, prevention, and research of mental illnesses, including substance use disorders. Visit the APA at www.psychiatry.org.

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