Medicaid Behavioral Health Coverage: Addressing the Mental Health and Substance Use Crisis

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Mental health and substance use disorders are pervasive in the United States, affecting millions of people each year. In fact, poor mental health is the leading cause of disability worldwide.

According to the National Institute of Mental Health, an estimated 1 in 5 adults in the United States experience a mental illness in any given year, and 1 in 12 adults experience a substance use disorder. These statistics underscore the vital importance of access to quality behavioral health services, including substance use and mental health treatment.

Fortunately, Medicaid provides coverage for many individuals with low incomes, including those with mental health and substance use disorders. Medicaid is the largest payer for behavioral health services in the United States, covering a range of services, including mental health counseling, substance use disorder treatment, and medication-assisted treatment.

However, the extent and quality of Medicaid behavioral health coverage vary significantly from state to state. To better understand the landscape of Medicaid behavioral health coverage, the Kaiser Family Foundation (KFF) conducts annual surveys of state Medicaid programs. In its most recent survey, conducted in 2022, KFF found that states are making progress in expanding access to behavioral health services for Medicaid enrollees, but significant gaps in coverage remain.

For example, while all states cover mental health outpatient services, only 45 states cover residential treatment for substance use disorder. Similarly, while all states cover medication-assisted treatment for opioid use disorder, only 28 states cover medication-assisted treatment for alcohol use disorder. These gaps in coverage can create significant barriers to care for individuals seeking treatment for substance use disorders, particularly those with co-occurring mental health conditions.

Moreover, KFF found that many states have not fully implemented the Medicaid behavioral health parity requirements established by the Affordable Care Act (ACA), which requires that mental health and substance use disorder services be covered at the same level as physical health services. In some cases, states have implemented parity requirements but have not fully enforced them, resulting in disparities in access to care for Medicaid enrollees with behavioral health needs.

The COVID-19 pandemic has also highlighted the critical need for Medicaid behavioral health coverage. The pandemic has increased stress and anxiety for many individuals, leading to a surge in demand for mental health services. According to a survey by the Centers for Disease Control and Prevention, the percentage of adults with recent symptoms of anxiety or depressive disorder increased from 36.4% in August 2020 to 41.5% in February 2021. Medicaid hopes these measures will ensure that individuals with low incomes have access to the behavioral health services they need during this challenging time.

Medicaid plays a critical role in providing access to behavioral health services for individuals with low incomes, including those with mental health and substance use disorders. However, significant gaps in coverage remain, and states must work to fully implement and enforce the Medicaid behavioral health parity requirements established by the ACA. By doing so, states can help to ensure that individuals with behavioral health needs receive the care and support they need to live healthy and fulfilling lives.

Did you know ACA plans cover mental and behavioral health? Get started offering coverage that matters to your clients!

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What to Know About Extended Medicaid Coverage for Mothers

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Health insurance agents, we have some great news to share with you that can benefit your clients. Several states have extended their Medicaid coverage program for postpartum care, allowing new mothers to access crucial healthcare services after giving birth.

As you know, the Affordable Care Act (ACA) provides states with the option to expand their Medicaid coverage for new mothers up to a year after childbirth, instead of the usual 60-day limit. Currently, 17 states (plus Washington, D.C.) have implemented the expansion program, and more states are expected to follow suit in the near future.

As an agent, it’s important to be aware of the expanding postpartum Medicaid coverage program and inform your clients of this option. Many new mothers may not be aware of this extension and could miss out on the opportunity to receive necessary medical attention during the first year of their child’s life.

Under the extension program, new mothers have access to services such as routine check-ups, mental health support, and family planning services. This can make a significant difference in their postpartum healthcare journey and ultimately lead to better health outcomes for both mother and child.

If you have clients who are new mothers or expecting, be sure to inform them of the postpartum coverage extension and encourage them to take advantage of it. If you’re not sure if your state has implemented the program, check with your local Medicaid office or healthcare provider to find out.

By staying informed and educating your clients on the expanding postpartum Medicaid coverage program, you can help improve their access to healthcare services and ensure they receive the best possible care during this important time in their lives.

Are you familiar with Medicaid Unwinding?

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Tennessee Makes Strides to Reduce Redetermination Process for Tenncare Coverage

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Tennessee has long been a leader in providing quality healthcare coverage through its Tenncare Medicaid program. Recently, the state has taken steps to make sure that their citizens are receiving the most up-to-date coverage and the best possible service. In this blog post, we’ll explore how Tennessee is working to reduce the redetermination process for Tenncare coverage, and what it means for Medicaid health plans in the state.

Tennesseans have long relied on Tenncare as their source of health coverage. However, there have been issues with the redetermination process, with some patients not receiving the coverage they need in a timely manner. This is especially true for those who are already struggling financially and have limited access to healthcare.

Fortunately, Tennessee has recently made strides to reduce the redetermination process. They have implemented an automated system too quickly and accurately assess a patient’s eligibility for Tenncare coverage. This system allows Tenncare to quickly process applications and provide coverage to those who need it most.

In addition to this automated system, Tennesseans will also benefit from new regulations that ensure that Tenncare coverage is provided in a timely fashion. The new regulations require Tenncare to inform individuals within 21 days of their application if they are approved or denied coverage. This will reduce the wait time for those seeking coverage, and make sure that they are not left without the coverage they need.

Finally, Tennesseans will benefit from the expansion of Medicaid health plans in the state. Tenncare has recently added additional plans to its network, giving Tennesseans more options for health coverage. This expansion of choices will give Tennesseans the opportunity to find an affordable plan that fits their needs.

Tennessee is taking the necessary steps to ensure that all Tennesseans get the coverage they need in a timely and efficient manner. The steps they are taking to reduce the redetermination process for Tenncare coverage and expand Medicaid health plans in the state are sure to benefit all Tennesseans. With these changes, Tennesseans can rest assured that they are getting the quality healthcare coverage they need.

Take a look at how Agility can help you with consumers that have lost their Medicaid coverage

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Continuous Enrollment Unwinding

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During a CMS National Stakeholder call, the omnibus spending plans were discussed as it relates to the recent spending plan proposed by Congress that would allow states to resume Medicaid continuous enrollment unwinding after the end of the first quarter of 2023. This post outlines a few key points about the unwinding of the Medicaid continuous enrollment requirement and the associated provisions in the bipartisan spending plan.

The proposed law makes it clear that states can take up to a full year to initiate all renewals. CMS has previously issued guidance allowing states up to 14 months to resume routine eligibility and enrollment processes; 12 months to initiate renewals and an additional two months to complete the process.

Extended federal funding will help states avoid the fiscal cliff. In the first quarter of 2023, states will continue to receive the 6.2 percentage point increase in the Federal Medical Assistance Percentage (FMAP). The increased FMAP is phased down for the remaining quarters in 2023 for states that meet requirements.

In order to qualify for the ongoing FMAP bump, states must meet certain maintenance of effort requirements, including using the temporary Section 1902(e(14)(A) flexibilities to smooth out the unwinding and avoid procedural un-enrollments or other processes and procedures approved by CMS. States must also meet specific data reporting requirements.

States must make a good-faith effort to locate enrollees for whom mail has been returned. Attempts must be made to ensure that it has up-to-date contact information using the National Change of Address Database Maintained by the United State Postal Service, other public program information, or other reliable sources of contact information. Additionally, the state may not disenroll anyone on the basis of returned mail until the state has made a good-faith effort to contact the individual using more than one communication mode.

Congress establishes state unwinding data reporting requirements and establishes penalties for non-compliance. If a state does not meet specific reporting requirements, it will be penalized with a reduction in its FMAP. Furthermore, CMS guidelines have been given additional authority to hold states.

Let Agility help you work with potential clients that may be losing their Medicaid.

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Health Care Service Corporation Launches Biggest Expansion of Medicare Advantage Plans in Company’s History

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Health Care Service Corporation Launches Biggest Expansion of Medicare Advantage Plans in Company’s History

Medicare-Eligible Beneficiaries Have Greater Choice Of Medicare Products Through Expanded Footprint in Over 90 New Counties


CHICAGO — Health Care Service Corporation (HCSC), which operates health plans in Illinois, Montana, New Mexico, Oklahoma and Texas, announced the company is increasing its footprint in the Medicare Advantage market to serve more than 90 new counties, increasing access to new coverage options for more than 1.1M additional Medicare-eligible individuals. The expansion is the company’s largest service area and product expansion in its history, particularly in rural and underserved areas.

HCSC’s Medicare Advantage plans allow Medicare eligible individuals greater flexibility and choice in coverage, offering enhanced benefits and greater value. Premiums can vary by geography, including some $0 premium HMO and PPO plan offerings. Medicare Advantage plans may also provide additional benefits beyond traditional Medicare, including (or the option to purchase) dental, vision, and hearing coverage at a variety of price points in a simple and easy to understand plan design.

“We are delighted to be offering Medicare plans in more counties than at any point in our history; bringing greater access to care than ever before to more Medicare beneficiaries across our five states, with some gaining access to such plans for the very first time,” said Christine Kourouklis, president of Medicare, HCSC. “For more than 90 years, HCSC has been dedicated to expanding access to high-quality, cost-effective health care. This expansion continues our focus on that longstanding commitment by broadening our Medicare footprint.”

Through this expansion, HCSC is focusing beyond major metropolitan areas to provide needed access and choice to the rising population of those aging into Medicare– projected to increase to nearly 80 million people nationwide over the next decade, according the Centers for Medicare & Medicaid Services (CMS).

“We’ve chosen expansion markets very carefully to select areas where we are confident we can successfully leverage our strong reputation and the strength of our relationships with doctors and hospitals, as well as offering coverage for new potential customers,” said Nathan Linsley, senior vice president, Government Programs, HCSC. “Our Medicare Advantage plans will continue to provide greater choice, emphasize affordability, and are designed to help Medicare beneficiaries meet their health, lifestyle, and financial goals.”

To accommodate the expansion, HCSC significantly increased its broad network, adding 19,000 physicians and 2,800 hospitals and other medical facilities across its five states.

HCSC is in the process of seeking all necessary regulatory approvals in its targeted states for 2022. The Medicare Advantage and Prescription Drug Plan Annual Election Period (AEP) starts October 15, 2021 and ends December 7, 2021. For more information, visit www.medicare.gov.

Press release by: Jori Fine, Health Care Service Corporation

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