Mental health care is hard to find, especially if you have Medicare or Medicaid : Shots - Health News A report from the Department of Health and Human Services' inspector general finds a dire shortage of mental health care providers in Medicaid and Medicare, which together serve some 40% of Americans.

Mental health care is hard to find, especially for people with Medicare or Medicaid

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MARY LOUISE KELLY, HOST:

The United States is in the midst of an unprecedented mental health crisis. Suicide rates and opioid deaths have risen over the past decade. Rates of anxiety and depression in children have soared. And accessing care for mental health issues continues to be a challenge, particularly for the country's most vulnerable populations. A new government report finds there is a dire shortage of mental health providers who accept Medicare and Medicaid. Here to tell us more is NPR health correspondent Rhitu Chatterjee. Hey, there.

RHITU CHATTERJEE, BYLINE: Hi, Mary Louise.

KELLY: All right. Tell us who wrote this report, what part of the government is it coming from, and a little more about its findings.

CHATTERJEE: Yeah. So this report is from the inspector general for the federal health department, and it looked closely at 20 counties across the country to see how people who get their health insurance from the government are able to access mental health care. And I'm talking about people on traditional Medicare and Medicare Advantage, so mostly seniors and people with disabilities, and then Medicaid, which is for those on low incomes. And the report found that, you know, on average, all three programs had fewer than five mental health care providers for every 1,000 enrollees in most counties. And some didn't even have a single provider for the same number of people.

KELLY: Fewer than five for every thousand people, that is - that's shockingly low.

CHATTERJEE: Yeah. And I should point out that the need for mental health care is really high in this population. Here's Meridith Seife, the regional inspector general and the lead author of the report.

MERIDITH SEIFE: You have 1 in 4 Medicare enrollees who are living with a mental illness, yet less than half of those people are receiving treatment. And in Medicaid, the need is really even greater. You have 1 in 3 adult enrollees living with a mental illness, and you have 1 in 5 living with a substance use disorder.

CHATTERJEE: And, you know, given that Medicaid and Medicare together serve nearly 130 million people, we're talking about millions of people not getting the care they need. And the report also found that a significant number of people also have to travel for a long time to see a counselor or a psychiatrist, which, as you can understand, can make it really unsustainable in the long run.

KELLY: OK. So let's talk about what's behind this. Why are there so few providers participating in these programs?

CHATTERJEE: So, you know, part of it is a nationwide shortage of mental health clinicians. But for Medicaid and Medicare, that's not the whole story. The report found that only a third of all providers in these counties are participating in these programs. And one big reason is that the programs don't pay mental health care professionals very well. Here's Deborah Steinberg. She's a senior health policy attorney at the nonprofit Legal Action Center.

DEBORAH STEINBERG: In the Medicare program, they set a physician fee rate. And then for certain providers, which includes clinical social workers, it includes the newly covered mental health counselors and marriage and family therapists, they get reimbursed at 75% of that rate.

CHATTERJEE: And Medicaid pays even less. And then on top of that, there are huge amounts of paperwork that both programs require. So that discourages participation, too.

KELLY: So briefly, Rhitu, who's trying to fix this?

CHATTERJEE: So the Center for Medicare and Medicaid Services, CMS, has taken some steps. So, for example, it's increased payments. But experts say, you know, a lot more needs to be done to address these shortages.

SEIFE: NPR's Rhitu Chatterjee. Thank you.

CHATTERJEE: Thank you, Mary Louise.

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