Vulnerable Americans are forgoing mental healthcare during the COVID-19 pandemic, CMS data shows

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The ongoing COVID-19 public health emergency is continuing to have an impact on Medicaid and Children's Health Insurance Program (CHIP) beneficiaries, as well as the utilization of health services, according to data from the Centers for Medicare and Medicaid Services. Specifically, Americans have been forgoing primary, preventive and mental healthcare visits.

According to data culled from March through October 2020, utilization rates have rebounded to pre-pandemic levels for some treatments, but mental health services have shown the slowest rebound.

This decline in utilization is occurring at a time when preliminary evidence shows mental health conditions have worsened nationwide. The gap in service utilization due to the PHE, particularly for mental health services, may have a substantial impact on long-term health outcomes. 

Medicaid and CHIP-funded mental health services, in addition to primary and preventative services, cover the majority of children, people living in poverty and those with special healthcare needs. Medicaid and CHIP also cover millions among racial and ethnic minorities.

WHAT'S THE IMPACT?

To help close this gap in services, CMS is emphasizing mental healthcare in its recently launched Connecting Kids to Coverage National Campaign, a national outreach and enrollment initiative funded under the Children's Health Insurance Program Reauthorization Act (CHIPRA) and the Affordable Care Act. The campaign reaches out to families with children and teens eligible for Medicaid and CHIP.

The ultimate goal is to achieve mental health parity, expand access to mental healthcare and eliminate the stigmas associated with it. 

Funding from the Biden Administration is slated to go toward addressing these issues. In addition to improving access to services provided to Medicaid and CHIP beneficiaries, the American Rescue Plan provided funding to address mental health and substance use challenges, including $3 billion in funding for block grants to address mental health and substance use prevention, treatment and recovery services. This is alongside $1.4 billion to support the mental health needs of healthcare professionals and first responders, as well as funding specifically for pediatric mental health.

CMS data shows a 34% decline in the number of mental health services utilized by children under the age of 19, compared to the same time period in 2019, and a 22% decline in the number of mental health services utilized by adults aged 19 to 64. This translates to about 14 million fewer mental health services for children and roughly 12 million fewer mental health services for adults. That adds up to nearly 26 million fewer mental health services utilized across both groups. 

Although there are preliminary reports of increased drug-related mortality due to the COVID-19 pandemic, substance use disorder service utilization also fell by 3.6 million services when compared to the same time period in 2019. The figure represents a 13% decline.

OTHER RESULTS

Importantly, the data shows that utilization rates for certain primary and preventive services for children under age 19 have recovered to pre-pandemic levels, or have started to rebound across many areas of the country. 

While this recovery is encouraging, millions of services still need to be delivered to make up for those missed between March and October 2020. Preliminary 2020 data shows 9% fewer childhood vaccinations for beneficiaries under age two (1.8 million services), 21% fewer child screening services (4.6 million services) among children under age 19, and 39% fewer dental services (11.4 million services) among children under age 19, when compared to pre-pandemic levels. This data takes into account increases in telehealth utilization.

Consistent with its stance throughout the public health emergency, CMS is encouraging states to consider telehealth options to combat COVID-19 and increase access to care. The updated data snapshot demonstrates a significant increase in the number of services delivered via telehealth compared to prior years. The number of services delivered via telehealth surged 2,700% during the PHE to nearly 68 million between March and October 2020. This increase, though, has not been enough to offset the decline in service utilization in other areas.

For COVID-19 treatment and acute care use, the preliminary findings show more than 1.2 million Medicaid and CHIP beneficiaries received COVID-19 treatment, and nearly 124,000 were hospitalized through October 2020. Despite significant variance across states regarding this data, preliminary results suggest that the COVID-19 treatment rate increases with age. 

In addition, Medicaid and CHIP paid for nearly 10 million COVID-19 tests or testing related services, although this data does not include tests provided free of charge or covered by other insurance programs, including Medicare.

THE LARGER TREND

The COVID-19 pandemic is increasing the demand for telehealth, driving consumers to increasingly seek virtual care options. The search is extending to behavioral health services, according to a March report from health insurer Cigna.

Part of the uptick in demand for virtual behavioral health is attributable to a general rise in the pursuit of mental healthcare services, the data showed, with a 27% increase in behavioral health outpatient care compared to pre-pandemic levels.

Sixty-three percent of all behavioral patients were female (vs. 48% pre-COVID-19), with women seeking care at higher rates than men across all age and ethnic groups, while 45% of those seeking behavioral care were under 30. About 18% were under age 18 – an 18% increase from before the pandemic – and 27% were aged 18-29, a 33% increase.

A recent study showed that mental health services accounted for the most common use of telehealth during the early days of the pandemic. In the midst of skyrocketing depression rates, the findings show that more patients used telehealth for behavioral rather than physical conditions.

ON THE RECORD

"More than 100 million Americans, including 43 million children, relied on us to deliver access to mental health and other services they needed through Medicaid and CHIP in 2020," said CMS Acting Administrator Liz Richter.

"Medicaid is the largest payer in the nation for mental health and that care is a lifeline for many. This new data provides a window into the impacts of the pandemic for marginalized communities – particularly children and other vulnerable people – and is critical as we work towards meeting the needs of those that rely on Medicaid and CHIP.

"While we're encouraged that people are accessing some healthcare services at pre-pandemic levels, there is work to do to connect people to mental healthcare services and to ensure we fill the gap in other types of services that was caused by the pandemic. The Centers for Medicare & Medicaid Services is committed to connecting people and children to healthcare – including mental healthcare."

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com