Medicaid cuts are likely to worsen mental health care in rural America
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Medicaid cuts are likely to worsen mental health care in rural America
Medicaid is the single largest payer for mental health care in the U.S. Experts say cuts in the massive tax and spending bill will worsen mental health disparities. Many will simply forgo care for depression, bipolar disorder and other illnesses. Small rural hospitals often provide critical behavioral health care access, he said.. One analysis found the cuts next year would leave 380 rural hospitals at risk of shutting down. The new law creates work requirement exceptions for those with severe medical conditions, including mental disorders. The exact qualifications and diagnoses for the exceptions haven’t been spelled out, according to a report by KFF, a health policy research organization. It’s so counter to the reality,’ said Dr. Heidi Alvey, an emergency and critical care medicine physician in Indiana. “You can’n’T work when your mental illness is not treated,” she said. ‘You can have a rural psychologist or a rural clinical social worker working under a shingle, literally alone’
Across the nation, Medicaid is the single largest payer for mental health care, and in rural America, residents disproportionately rely on the public insurance program.
But Medicaid cuts in the massive tax and spending bill signed into law earlier this month will worsen mental health disparities in those communities, experts say, as patients lose coverage and rural health centers are unable to remain open amid a loss of funds.
“The context to begin with is, even with no Medicaid cuts, the access to mental health services in rural communities is spotty at best, just very spotty at best — and in many communities, there’s literally no care,” said Ron Manderscheid, former executive director of the National Association of County Behavioral Health and Developmental Disability Directors.
Cuts over the next 10 years could force low-income rural families to pay for mental health care out of pocket on top of driving farther for care, experts say. Many will simply forgo care for depression, bipolar disorder and other illnesses that need consistent treatment.
“Not only do you have very few services available, but you don’t have the resources to pay for the services,” Manderscheid said. “That makes the problem even worse.”
Rural communities are already at higher risk of suicide, with rates almost doubling over the past two decades. Already, rural communities are grappling with a shortage in mental health professionals, making them more vulnerable to losses compared with more urban areas, experts say.
Paul Mackie, assistant director of the Center for Rural Behavioral Health at Minnesota State University, Mankato, studies rural mental health workforce shortages.
“If it [coverage] goes away, what would then be the person’s next option if they already don’t have the resources?” said Mackie, who grew up on a rural Michigan dairy farm. “You can have a rural psychologist or a rural clinical social worker working under a shingle, literally alone.”
Small rural hospitals often provide critical behavioral health care access, he said. One analysis found the cuts next year would leave 380 rural hospitals at risk of shutting down.
Under President Donald Trump’s signature legislation, states that expanded Medicaid through the 2010 Affordable Care Act will have to redetermine eligibility twice a year on millions enrolled in the program. Some Medicaid recipients also will have to prove work history.
The new law creates work requirement exceptions for those with severe medical conditions — including mental disorders and substance use — but experts say proving those conditions may be convoluted. The exact qualifications and diagnoses for the exceptions haven’t been spelled out, according to a report by KFF, a health policy research organization.
“You can’t work when your mental illness is not treated,” said Dr. Heidi Alvey, an emergency and critical care medicine physician in Indiana. “It’s so counter to the reality of the situation.”
Alvey worked seven years at Baylor Scott & White Health’s hospital in Temple, Texas. As nearby rural critical access hospitals and other mental health centers shut down, the hospital became the only access point for people hours away, she said.
“People who just had absolutely no access to care were coming hours in to see us,” she said. Many had serious untreated mental health conditions, she said, and had to wait days or weeks in the emergency department until a care facility had an open bed.
She’s concerned that Medicaid cuts will only make those problems worse.
Jamie Freeny, director of the Center for School Behavioral Health at advocacy group Mental Health America of Greater Houston, worries for the rural families her center serves. The organization works with school districts across the state, including those in rural communities. Nearly 40% of the state’s more than 1,200 school districts are classified as rural.
She remembers one child whose family had to drive to another county for behavioral health. The family lost coverage during the Medicaid unwinding, as pandemic provisions for automatic re-reenrollment expired. The child stopped taking mental health medication and ended up dropping out of school.
“The child wasn’t getting the medicine that they needed, because their family couldn’t afford it,” Freeny said. “The catalyst for that was a lack of Medicaid. That’s just one family.
“Now, you’re multiplying that.”
Family medicine physician Dr. Ian Bennett sees Medicaid patients at the Vallejo Family Health Services Center of Solano County in California’s Bay Area. The community health clinic serves patients from across the area’s rural farm communities and combines primary care with mental health care services, Bennett said.
“When our patients lose Medicaid, which we expect that they will, then we’ll have to continue to take them, and that will be quite a strain on the finances of that system,” Bennett said. The center could even close, he said.
“The folks who are having the most difficulty managing their lives — and that’s made worse by having depression or substance use disorder — are going to be the folks most likely to drop off,” said Bennett, a University of Washington mental health services researcher. “The impacts down the road are clearly going to be much worse for society as we have less people able to function.”
The psychiatric care landscape across Michigan’s rural western lower peninsula is already scarce, said Joseph “Chip” Johnston. He’s the executive director of the Centra Wellness Network, a publicly funded community mental health care provider for Manistee and Benzie counties. The network serves Medicaid and uninsured patients from high-poverty communities.
“I used to have psychiatric units close by as an adjunct to my service,” he said. “And they’ve all closed. So, now the closest [psychiatric bed] for a child, for example, is at least two hours away.”
Those facilities are also expensive. A one-night stay in an inpatient psychiatric facility can be anywhere from $1,000 to $1,500 a night, he said.
Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org.
Medicaid cuts are likely to worsen mental health care in rural America
Yahoo is using AI to generate takeaways from this article. This means the info may not always match what’s in the article. Reporting mistakes helps us improve the experience. Across the nation, Medicaid is the single largest payer for mental health care. Medicaid cuts in the massive tax and spending bill signed into law earlier this month will worsen mental health disparities in those communities, experts say. Many will simply forgo care for depression, bipolar disorder and other illnesses that need consistent treatment, they say. The cuts next year would leave 380 rural hospitals at risk of shutting down, an analysis found. The new law creates work requirement exceptions for those with severe medical conditions, but experts say proving those conditions may be convoluted. The exact qualifications and diagnoses for the exceptions haven’t been spelled out, according to a report by KFF, a health policy research organization. It’s so counter to the reality of the situation, Dr. Heidi Alvey, an emergency and emergency medicine physician in Indiana, said.
Yahoo is using AI to generate takeaways from this article. This means the info may not always match what’s in the article. Reporting mistakes helps us improve the experience.
Yahoo is using AI to generate takeaways from this article. This means the info may not always match what’s in the article. Reporting mistakes helps us improve the experience. Generate Key Takeaways
People listen to a sermon before being admitted to lunch at the Hope Center, which assists homeless and addicted residents in Hagerstown, Md. Experts say Medicaid cuts will exacerbate rural communities’ access to mental health care. (Spencer Platt/Getty Images)
Across the nation, Medicaid is the single largest payer for mental health care, and in rural America, residents disproportionately rely on the public insurance program.
But Medicaid cuts in the massive tax and spending bill signed into law earlier this month will worsen mental health disparities in those communities, experts say, as patients lose coverage and rural health centers are unable to remain open amid a loss of funds.
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“The context to begin with is, even with no Medicaid cuts, the access to mental health services in rural communities is spotty at best, just very spotty at best — and in many communities, there’s literally no care,” said Ron Manderscheid, former executive director of the National Association of County Behavioral Health and Developmental Disability Directors.
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Cuts over the next 10 years could force low-income rural families to pay for mental health care out of pocket on top of driving farther for care, experts say. Many will simply forgo care for depression, bipolar disorder and other illnesses that need consistent treatment.
“Not only do you have very few services available, but you don’t have the resources to pay for the services,” Manderscheid said. “That makes the problem even worse.”
Advertisement Advertisement
Advertisement Advertisement
Rural communities are already at higher risk of suicide, with rates almost doubling over the past two decades. Already, rural communities are grappling with a shortage in mental health professionals, making them more vulnerable to losses compared with more urban areas, experts say.
Paul Mackie, assistant director of the Center for Rural Behavioral Health at Minnesota State University, Mankato, studies rural mental health workforce shortages.
“If it [coverage] goes away, what would then be the person’s next option if they already don’t have the resources?” said Mackie, who grew up on a rural Michigan dairy farm. “You can have a rural psychologist or a rural clinical social worker working under a shingle, literally alone.”
Small rural hospitals often provide critical behavioral health care access, he said. One analysis found the cuts next year would leave 380 rural hospitals at risk of shutting down.
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States such as Mackie’s Minnesota, which expanded Medicaid eligibility under the 2010 Affordable Care Act, would suffer significant slashes in federal matches as a result of President Donald Trump’s signature legislation. The law, which includes tax cuts that disproportionately benefit the wealthy, cuts the federal government’s 90% matching rate for enrollees covered under expansion to anywhere from 50% to 74%.
States will have to redetermine eligibility twice a year on millions enrolled under Medicaid expansion. Some Medicaid recipients also will have to prove work history. The new law creates work requirement exceptions for those with severe medical conditions — including mental disorders and substance use — but experts say proving those conditions may be convoluted. The exact qualifications and diagnoses for the exceptions haven’t been spelled out, according to a report by KFF, a health policy research organization.
Not only do you have very few services available, but you don’t have the resources to pay for the services. That makes the problem even worse.
– Ron Manderscheid, former executive director of the National Association of County Behavioral Health and Developmental Disability Directors
“You can’t work when your mental illness is not treated,” said Dr. Heidi Alvey, an emergency and critical care medicine physician in Indiana. “It’s so counter to the reality of the situation.”
Advertisement Advertisement
Advertisement Advertisement
Alvey worked seven years at Baylor Scott & White Health’s hospital in Temple, Texas. As nearby rural critical access hospitals and other mental health centers shut down, the hospital became the only access point for people hours away, she said.
“People who just had absolutely no access to care were coming hours in to see us,” she said. Many had serious untreated mental health conditions, she said, and had to wait days or weeks in the emergency department until a care facility had an open bed.
She’s concerned that Medicaid cuts will only make those problems worse.
Jamie Freeny, director of the Center for School Behavioral Health at advocacy group Mental Health America of Greater Houston, worries for the rural families her center serves. The organization works with school districts across the state, including those in rural communities. Nearly 40% of the state’s more than 1,200 school districts are classified as rural.
Advertisement Advertisement
Advertisement Advertisement
She remembers one child whose family had to drive to another county for behavioral health. The family lost coverage during the Medicaid unwinding, as pandemic provisions for automatic re-reenrollment expired. The child stopped taking mental health medication and ended up dropping out of school.
“The child wasn’t getting the medicine that they needed, because their family couldn’t afford it,” Freeny said. “The catalyst for that was a lack of Medicaid. That’s just one family.
“Now, you’re multiplying that.”
Family medicine physician Dr. Ian Bennett sees Medicaid patients at the Vallejo Family Health Services Center of Solano County in California’s Bay Area. The community health clinic serves patients from across the area’s rural farm communities and combines primary care with mental health care services, Bennett said.
Advertisement Advertisement
Advertisement Advertisement
“When our patients lose Medicaid, which we expect that they will, then we’ll have to continue to take them, and that will be quite a strain on the finances of that system,” Bennett said. The center could even close, he said.
“The folks who are having the most difficulty managing their lives — and that’s made worse by having depression or substance use disorder — are going to be the folks most likely to drop off,” said Bennett, a University of Washington mental health services researcher. “The impacts down the road are clearly going to be much worse for society as we have less people able to function.”
The psychiatric care landscape across Michigan’s rural western lower peninsula is already scarce, said Joseph “Chip” Johnston. He’s the executive director of the Centra Wellness Network, a publicly funded community mental health care provider for Manistee and Benzie counties. The network serves Medicaid and uninsured patients from high-poverty communities.
“I used to have psychiatric units close by as an adjunct to my service,” he said. “And they’ve all closed. So, now the closest [psychiatric bed] for a child, for example, is at least two hours away.”
Advertisement Advertisement
Advertisement Advertisement
Those facilities are also expensive. A one-night stay in an inpatient psychiatric facility can be anywhere from $1,000 to $1,500 a night, he said.
Stateline reporter Nada Hassanein can be reached at nhassanein@stateline.org.
Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org.
Hospitals across nation brace for Medicaid cuts under ‘big, beautiful’ law
Hospitals are bracing for the impact from the Medicaid cuts in President Trump’s sweeping spending and tax cut law. Most of the cuts won’t happen immediately, but rural facilities in particular say they likely will have to make difficult financial decisions about which services they can afford to keep and which may need to be cut. The new law cuts about $1 trillion from Medicaid, primarily through stringent work requirements and reductions to how states can fund their Medicaid programs. In rural communities, Medicaid covers nearly half of all births and one-fifth of inpatient discharges, according to health research group KFF. The most likely casualty will be new construction and expansion plans, but it’s too early to know more, an executive says. The law calls for the money to be distributed by the Centers for Medicare and Medicaid Services (CMS) to be split between rural hospitals and the federal government. The bill was only signed into law on July 4, so hospitals said it’re too early for them to know specifics on what services they’ll have to cut back on.
While most of the cuts won’t happen immediately, rural facilities in particular say they likely will have to make difficult financial decisions about which services they can afford to keep and which may need to be cut.
Hospitals loudly raised alarms about the legislation, but their warnings went unheeded, and now they say they will bear the brunt of the changes.
The new law cuts about $1 trillion from Medicaid, primarily through stringent work requirements as well as reductions to how states can fund their Medicaid programs through provider taxes and state directed payments.
Rural hospitals rely heavily on Medicaid funding because many of the patients they care for are low income.
“Restrictions on state directed payments and provider taxes cut off critical financial lifelines for hospitals,” Bruce Siegel, president and CEO of America’s Essential Hospitals said in a statement.
“State directed payments are a critical source of support for hospitals, particularly in rural areas, and provider taxes help reduce the gap between Medicaid and other payers, ensuring that physicians can take Medicaid patients and hospitals can be adequately staffed. Cutting these lifelines is not sustainable, and it will harm patients.”
More than 300 rural hospitals in the U.S. are at risk of closing down because of the bill, according to research conducted by the University of North Carolina’s Sheps Center for Health Services Research and released last month by Democratic lawmakers.
Rural hospitals already operate on thin margins. The law’s Medicaid cuts will lead to more uninsured patients, meaning rural hospitals will not get paid for the services they are required by law to provide to patients, according to the report. In turn, they will face deeper financial strain.
Medicaid-dependent services — like labor and delivery units, mental health care, and emergency rooms — are some of the least profitable, yet most essential, services that hospitals provide. But experts said those will likely be cut as hospitals try to stay afloat.
In rural communities, Medicaid covers nearly half of all births and one-fifth of inpatient discharges, according to health research group KFF.
Republicans pushed back the start date for the provider tax reductions until 2028, and they won’t be fully phased in until 2031. The bill was only signed into law on July 4, so hospitals said it’s too early for them to know specifics on which services they’ll have to cut back on.
But the discussions are underway because hospitals need to start planning.
“If they see a very negative outlook in terms of Medicaid revenue reductions, increases in uncompensated care costs, I think that will tip the scales towards cutting services, cutting staff, not hiring, not expanding,” said Edwin Park, a research professor at the McCourt School of Public Policy at Georgetown University.
Mark Nantz, president and chief executive officer of Valley Health System, oversees a network that includes six hospitals in the Shenandoah Valley of Virginia and West Virginia, ranging from a 495-bed regional facility in Winchester to a 36-bed facility in Front Royal, about 70 miles outside of Washington.
Nantz said Medicaid expansion and provider taxes have allowed the system to break even when taking care of Medicaid patients. Previously, they were losing about 25 cents on every dollar.
Once the cuts are fully phased in, Nantz said Valley Health will lose about $50 million a year in revenue for Medicaid patients. The most likely casualty will be new construction and expansion plans, but he said it’s too early to know more.
“We’re not in a situation where we need to knee-jerk because we’re a pretty stable healthcare system, but it’s definitely going to change the way we look at expanding and the types of services that we offer in our six hospitals,” Nantz said.
Valley Health was able to expand the services it offers because it was not losing money on Medicaid, but that may not be able to continue. While hospitals may not close, some types of specialty care may be moved from rural facilities and centralized at the regional facility.
“We’ve got, really, two and a half to three years to make those kinds of decisions and prepare for what we will do. So we’re not threatening to cut jobs or hospitals or service locations or any of that right now,” Nantz said, “but we have to look at whether or not we can continue” offering the same types of services.
Republicans concerned about the impact of the provider tax reduction on rural hospitals inserted a $50 billion relief fund into the law. The law calls for the money to be distributed by the Centers for Medicare and Medicaid Services (CMS) over five years.
The federal government will distribute half of the program’s $50 billion allotment equally among all states with an approved application over the next five years.
But experts said the money isn’t nearly enough to make up for the impact of the cuts. According to a KFF analysis, federal Medicaid spending in rural areas is estimated to decline by $155 billion over a decade.
The states and hospitals that will be hit the hardest will benefit the least, Park said.
He noted the law gives the Trump administration a lot of discretion on how they divide up the funds, so there’s potential for favoritism.
Every state has until the end of 2025 at the latest to apply for funds by submitting a “detailed rural health transformation plan” that addresses the program’s aims, according to the legislation.
But if CMS Administrator Mehmet Oz doesn’t agree with how states are using their funds, the law says he then “may withhold payments to, or reduce payments to, or recover previous payments from, the State.”
“It’s a fig leaf,” Park said. “The fund is temporary. These cuts are permanent.”
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