Medicaid Expansion Has Nearly Doubled Mental Health Resources In Some Areas, Report Says

By Darrell Ehrlick, Daily Montanan

July 1, 2021

A new report by the Montana Healthcare Foundation shows that since Medicaid Expansion in 2016, Montana has rapidly built out its mental health services and residents have utilized those services equally as rapidly.

The report studied how the expansion affected the state’s mental and behavioral health system. In short, Montana’s mental health providers in some cases nearly doubled in just four years, and services for those dealing with addiction showed huge increases.

“Medicaid expansion is fueling an expansion of Montana’s prevention and treatment system to address longstanding unmet needs, particularly in rural and tribal communities,” said Dr. Aaron Wernham, chief executive of the foundation. “Turning the tide on addiction, suicide and mental illness in our state will require steady leadership and dedicated investment for years to come.”

Among the findings highlighted:

Wernham said substance abuse is one of the areas of largest and most radical transformations. Before the expansion, only as many as 8% of those with substance abuse issues were able to access treatment. And, regardless of political affiliation, most Montana leaders have argued for expansion of mental health services to combat mental illness, addiction and the state’s high suicide rate.

“As this new report indicates, substance use disorder treatment services are becoming more widely available and utilized in Montana,” said Montana Department of Public Health and Human Services Director Adam Meier. “Gov. Gianforte’s plan to bolster the state’s current efforts to support substance use disorder and behavioral health care through the HEART Initiative will move Montana forward even more.”

Having more mental health services doesn’t just benefit those on Medicaid, it helps accessibility and availability across the state, said Kevin McAvey of Manatt Health, which conducted the research.

“With 1,400 people struggling with addiction, more than 260 people lost to alcohol and more than 250 people who took their own lives, it’s critical that we build out this system for the good of the state,” McAvey said. “And there’s $54 million of new federal funding that is helping to support these jobs.”

Wernham said the health foundation is interested in programming that helps reduce the number of people in medical crisis and prevention. He mentioned “Communities that Care,” which is a program aimed at bringing together law enforcement, health officials and community leaders to tailor programs aimed at substance abuse prevention. Or the PAX good behavior curriculum in many Montana schools.

Wernham likens what is happening in mental and behavioral health as the same kind of preventative program. For example, many patients are now screened for mental health issues at a primary care provider’s office.

“Just like the blood pressure cuff — it’s the same. It’s very treatable if you test for it, but you can’t tell just by looking at someone,” Wernham said. “It’s not obvious. The same is true for depression or other issues.”

He said that other benefits may become more apparent as the programs continue. For example, it may take some time before suicide or addiction statistics come down. However, Wernham said mental illness is the leading cause of disability so helping patients “upstream” get care could result in huge savings and other impacts beyond the healthcare system. Moreover anywhere from one-third to one-half of all emergency room visits are because of mental health or substance abuse, so more resources means less stress on already overworked emergency departments.

“We can take care of them before the crisis,” Wernham said.

He said some of the data suggests huge benefits. For example, there was an increase in utilization of mental health of nearly 90%, but the cost increase was only 53%. That means that more people are accessing the mental health benefits, but they tend to access services that are less expensive — likely counseling instead of trips to the emergency room or in-patient settings.

“We expected the direction of the findings. What we didn’t know was the quantity,” Wernham said.

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