Geography May Determine Accessibility of Mental Health Care Under Medicaid Expansion

States that opt to expand their Medicaid coverage under the new health care reform law—the Affordable Care Act—will see an increase in the number of enrollees needing mental health care. This is significant because Medicaid already funds more mental health services than any other payer in the United States. But concerns have been raised over whether there are enough mental health clinicians and facilities that accept Medicaid available to serve those new enrollees and whether this newly eligible population will face access obstacles. There is a particular severe shortage of such clinicians and facilities in many rural areas and in communities with large percentages of black or Hispanic residents, said Emory University’s Janet Cummings, Ph.D., Benjamin Druss, M.D., M.P.H., and colleagues, in JAMA Psychiatry online August 21. The effect size was largest for rural communities.

The researchers compared data from the 2008 National Survey of Mental Health Treatment Facilities with sociodemographic information from more than 3,100 U.S. counties.

“More than one-third of counties do not have any outpatient mental health facilities that accept Medicaid,” they pointed out. “If communities with a high concentration of black and/or Hispanic residents experience higher than average Medicaid enrollment but are more likely to lack these facilities, policies will need to be implemented to ensure that the Medicaid expansion does not exacerbate disparities in the accessibility of services for these communities.”

For more in Psychiatric News about the ACA’s effect on Medicaid patients, see “States’ Decisionon Expanding Medicaid Will Impact Inpatient Psychiatric Care.” Additional information on Medicaid funding for mental health care can be found in Psychiatric Services.

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