May is both Older Americans Month and Mental Health Awareness Month. Mental health is a critical issue for older Americans, as one in five seniors has a mental health issue, and older men have the highest suicide rate of any group, according to the CDC. The mental health needs of seniors and persons with disabilities who are dually eligible for Medicare and Medicaid are often overlooked in traditional medical settings, ramping up costs and leading to inadequate care. About 44% of dual eligibles have at least one mental or cognitive condition, while more than half of all Medicare inpatient psychiatric facility patients are duals. Stigma and inadequate screening mechanisms prevent beneficiaries from accessing behavioral health services. These needs affect some groups within the dual eligible population disproportionately. For example, nearly half of the under-65 dual eligible population have severe mental disorders, and this group’s health care costs are about double compared to young duals without severe mental health needs.
States and advocates need to focus attention on the behavioral health needs of these vulnerable populations. One way some states have focused on addressing the behavioral health needs of dual eligibles is through their demonstrations for Medicare-Medicaid enrollees. These demonstrations create new health plans for dual eligibles that seek to integrate Medicare and Medicaid services to provide more coordinated and timely care for beneficiaries.
For example, like other dual demonstrations, Cal MediConnect (California’s dual eligible demonstration) includes the integration of behavioral health. Under this arrangement, county behavioral health agencies, who are responsible for delivering specialty mental health services for Medicaid beneficiaries, entered into memoranda of understanding with Cal MediConnect health plans. Although the agencies themselves remained responsible for providing specialty mental health services under a carve-out, counties are now required to coordinate with the health plans to ensure people have seamless access to mental health care. Cal MediConnect plans are responsible for providing members with mild to moderate mental health services.
The integration of the behavioral health benefit in California has faced challenges, but holds real potential. Changes of this magnitude require institutional cultural shifts in that do not happen overnight. County behavioral health agencies are not used to sharing information and coordinating with managed care plans, and vice versa. In Los Angeles, advocates have reported that while some mental health providers fail to grasp the importance of completing care plans and other managed care requirements, but when providers do participate fully, the experience has been extremely positive for the older adults and persons with disabilities they serve. In particular, beneficiaries have benefitted from the process of integrating behavioral health and physical health providers through care plans and care teams.
Survey results released just last week from the University of California (San Francisco and Berkeley) found older adults enrolled in Cal MediConnect who accessed behavioral health services were more likely to have a care coordinator, a key feature of dual demonstration plans. Care coordinators can help ensure beneficiaries get the right care at the right time for all their health needs, including behavioral health, but also others like long-term services and supports. No significant differences were found between beneficiaries enrolled in Cal MediConnect and those who opted out with respect to their behavioral health care experiences.
While dual demonstrations like Cal MediConnect offer one opportunity to improve the delivery system for this population, advocates in all states have opportunities to encourage their states, health plans, and community mental health agencies to prioritize the mental health needs of older adults. This may mean reviewing and revising screening mechanisms and referral processes among the different tiers of behavioral health needs. It may mean adopting best practices from states and community-based organizations with respect to outreach and education strategies regarding individuals with severe mental illness, or ensuring care coordinators at managed care plans are trained in how dementia and Alzheimer’s Disease affect this population. Advocacy on this front, whether within dual demonstrations or more broadly, will empower older adults with mental health needs to thrive in their community.