SAMHSA Executive Talks Medicare & Mental Health

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The Centers for Medicare & Medicaid Services recently sponsored a webinar entitled, Medicare & Mental Health,” as part of its ongoing National Training Program online learning series. The webinar featured a presentation by Mariel Lifshitz, MPH, Special Assistant for Healthcare Financing at the Substance Abuse and Mental Health Services Administration’s (SAMHSA) Center for Mental Health Services.

Lifshitz outlined the serious challenges facing our health care system, including high rates of mental illnesses and substance use disorders among Medicare and Medicaid populations.

Today, approximately 20 percent of adults ages 55 and older have experienced some type of mental health concern, such as depression,” Lifshitz said. Men over the age of 80 have the highest suicide rate in the nation, and projected increases in lifetime illicit drug use among the baby boomer generation will likely require greater substance use interventions in the years to come.”

She continued by explaining that high rates of dual eligibles — that is, persons who qualify for both Medicare and Medicaid — remain a challenge, as those individuals are often the most chronically ill, and their treatment has significant cost implications. According to Lifshitz, dual-eligible individuals accounted for 19 percent of Medicare enrollees but 34 percent of spending in 2009.

Fortunately, there are established federal and state programs that can help counselors and health care providers treat older adults who are facing these serious health issues, Lifshitz continued. Medicare Part A covers inpatient psychiatric hospitalization, detoxification and drug treatment. Part B will cover visits with psychiatrists, social workers and other health professionals outside the hospital setting. Part D prescription plans are required, with a few exceptions, to cover medications such as antidepressants and antipsychotics. Lifshitz also identified several recent innovations that health care service providers can leverage, including Accountable Care Organizations, Health Homes and Certified Community Behavioral Health Clinics.

Challenges do exist, however, including a limit on inpatient treatment to 190 days, restrictions on prescription benefits, and limitations on where Medicare beneficiaries can receive care.

Lifshitz recommended that providers ask three key questions when considering how to best care for Medicare and Medicaid recipients dealing with mental illness and substance use issues:

  1. What are the individual’s service and treatment needs? Thoroughly review their medical history to better anticipate future interventions.
  2. Identify if the individual is dually eligible and determine how to leverage the two systems to improve care and overall health outcomes.
  3. Explore what innovations exist in an individual’s state that can assist them in their treatment.

For more information about SAMHSA and Medicare coverage for behavioral and mental health issues, visit mentalhealth.gov or samhsa.gov.