One in five adults, adolescents, and youth – over 50 million Americans – experienced a behavioral health issue between 2019 and 2020. However, less than half of all adults with a mental health issue had timely access to care in 2021, and those with a substance use disorder were even less likely to access care.

Medicare, Medicaid, and Marketplace plans serve a larger population of patients with behavioral health needs when compared with most private insurance plans – and Medicaid is the single largest payer for behavioral health care services in the U.S. And yet, behavioral health care providers participate less in these insurance plans, and the distribution of these professionals across the U.S. remains misaligned with patient needs

In a new report released by the National Academies of Sciences, Engineering, and Medicine, HBHI Director Dan Polsky and a team of authors, along with a committee of 17 experts from multiple sectors, provide strong recommendations for federal agencies to address this gap.

“Our report offers recommendations to greatly expand the behavioral health workforce’s participation in Medicare, Medicaid, and Marketplace insurance,” said Daniel Polsky, chair of the committee that wrote the report and Bloomberg Distinguished Professor of Health Economics and Policy at Johns Hopkins University. “There are many valid reasons why providers might not participate – they could be paid less, and the administrative burden is high – so we recommend reforms that will make the system work better for care providers, patients, and the health care system as a whole.”

The National Academies of Sciences, Engineering, and Medicine are private, nonprofit institutions that provide independent, objective analysis and advice to the nation to solve complex problems and inform public policy decisions related to science, engineering, and medicine. Undertaken by the Committee on Strategies to Improve Access to Behavioral Health Care Services through Medicare and Medicaid, the study was sponsored by the Centers for Medicare &  Medicaid Services and the Substance Abuse and Mental Health Services Administration through A-G Associates.

To improve access to behavioral health care, the report finds three major areas of focus: making provider participation worthwhile, easing entry into public insurance, and optimizing performance and accountability. Recommended strategies for achieving these goals include setting more appropriate reimbursement rates, reducing administrative burdens on providers, streamlining credential processes, and developing standards for managed care plans that carry significant financial penalties and bonuses based on outcomes.

Find the full report here, along with research highlights, a policy brief for states, and an action guide for providers.