Medicaid expansion creates explosion in demand for mental health care

By Jane Hoback

Mental health centers in Colorado are seeing a surge in new clients seeking services under the state’s expansion of Medicaid. And while center officials say they expected an increase, the number of new calls surprised them, so they have ramped up efforts and instituted new programs to meet the demand.

As part of the Affordable Care Act, Colorado is among 26 states that expanded Medicaid benefits for adults who earn up to 138 percent of the federal poverty level, about $16,000 for a single person. The state’s Medicaid expansion enrollment totaled 178,500 people who signed up from Oct. 1 to April 15.

Mental health leaders say the Medicaid increases point to a huge pent-up demand for services among people with a variety of issues who until now have not been able to get the help they need.

Kelly Phillips-Henry, chief operating officer for AspenPointe Inc.

Kelly Phillips-Henry, chief operating officer for AspenPointe Inc.

“This gives us an opportunity to serve a population that is so in need of care,” said Kelly Phillips-Henry, chief operating officer of AspenPointe, a mental health center in Colorado Springs. “Now we can try to figure out how to reach people before it becomes a psychiatric emergency. That’s really the target of what we’re trying to do.”

Michelle Hoy, regional director of Mindsprings Health in Grand Junction, said, “It’s an exciting time. There’s been a lot of attention given to mental health issues, and more people are seeking help. They’re learning that there is help out there and that they can get better.”

State officials say it’s too soon to provide comprehensive statewide data on the number of people who are accessing mental health services under Medicaid expansion. But mental health centers have been racking up rising numbers every month.

“Well before the expansion took effect, there was a pretty aggressive effort to get as many people as possible signed up for Medicaid,” said Dr. Carl Clark, president and CEO of the Mental Health Center of Denver. “So we expected an increase. We were a little bit surprised that it worked so well. It’s more than we expected, and we didn’t think it would happen so fast.”

The Mental Health Center of Denver is one of 17 community mental health centers in Colorado’s public mental health system that provides services to Medicaid recipients. Medicaid is the single largest payer for mental health services in the U.S., paying for nearly half of all publicly funded mental health services.

The federal Substance Abuse and Mental Health Services Administration estimates that about 18 percent of Colorado adults have a mental illness.

“Now that they have insurance, they can get the help they need,” said Mindsprings’ Hoy. The center has 14 offices in 10 Western Slope counties.

Mindsprings’ Grand Junction office saw an increase from about 250 people a month to 350 a month since January. Most of the increase was Medicaid, Hoy said.

The Mental Health Center of Denver saw calls rise from 2,030 in January to 2,156 in March. Calls in March 2013 were 1,500. Clark said totals for the last fiscal year, which runs from July through June, were 6,400. Calls this fiscal year – July through March – already have totaled 6,400.

Dr. Carl Clark

Dr. Carl Clark

“I’m pretty sure the increase is almost all due to the Medicaid expansion,” Clark said. “Now that people have coverage, they’re calling.”

The Jefferson Center for Mental Health, which includes Jefferson, Gilpin and Clear Creek counties, also is seeing “astonishing increases,” said President and CEO Harriet Hall.

Medicaid admissions in January, February and March of 2012 and 2013 averaged about 200 a month, Hall said.

This year, Medicaid admissions were 335 in January, 296 in February and 368 in March.

And the calls keep coming. Hall predicts admissions will continue to rise. “All of the people we know are out there who are eligible are not signed up yet.”

AspenPointe, which includes El Paso, Park and Teller counties, has seen an influx as well. In May, the three-county region had 140,000 Medicaid-eligible people, up from 95,000 in December 2013.

“Typically, we see about 12 to 15 percent of the (Medicaid) population,” said Phillips-Henry of AspenPointe. “Normally with Medicaid we have been serving between 13,000 and 15,000 (people). But this year I wouldn’t be surprised if we see 21,000 by the end of the year.”

Outreach efforts to enroll people in Medicaid also have resulted in what is being called a “woodwork effect”: People who qualified for Medicaid even before the expansion are signing up for the first time.

Hiring as fast as they can

Because the centers anticipated at least some of the increase, so far they’ve been able to keep up with demand. They have instituted same-day or walk-in appointments. In addition to individual therapy sessions, they are steering more people toward group sessions and peer services, when appropriate.

“We’ve done planning to make sure we can see everybody,” the Jefferson Center’s Hall said. “It’s taking a little longer to get people assigned to ongoing treatment unless their need is pretty urgent.

“We’re stretched, but we’re handling it. We’re hiring as fast as we can so that’s a temporary and not a permanent problem.”

The center employs between 200 and 300 clinical staff members, and Hall expects the number to rise to more than 400 in the next year.

Mindsprings also plans to add to its 450 employees at some point, though “right now we have adequate staff and resources to meet the demand,” Hoy said. “And we really are using all of our resources – whether it’s individual therapy, group therapy, peer services. We have a variety of ways to meet the needs of our new customers.”

She said some new clients might have symptoms that are worse than if they had been able to seek treatment sooner. Mindsprings also emphasizes a long-term goal of helping people learn skills to take care of themselves so they might not have to seek services.

Same day appointments

To help drive down no-show rates, all psychiatrists at the Mental Health Center of Denver carve out specific times every day to see clients on the same day they call.

“They made that phone call. They’re ready,” Clark said. “We don’t have to tell them they have to wait two weeks for an appointment. If you’re in the hospital, we get you in. If you’re outpatient, we get you in.”

As a result, about 75 to 80 percent are showing up for their first appointment, up from 50 percent before the new program, Clark said.

The center also has an expansion track, which eliminates some of the paperwork for shorter-term clients who probably will need to come in for no more than eight appointments.

Clark said the center has grown from about 500 employees before the Medicaid expansion to 600 and will grow to about 700 in the next year. It has 50 openings now.

The biggest challenge is hiring psychiatrists, due in part to a national shortage, as well as nurse practitioners, physician assistants and licensed bilingual staff.

AspenPointe also offers walk-in hours as well as more group sessions. It eventually plans to add late-night and weekend hours and expand its Lighthouse acute-treatment services. It is moving toward what Phillips-Henry calls care teams, which might include a psychiatrist, counselor, health coach, case manager and vocation specialist, depending on the client’s needs.

AspenPointe employs about 550 staff members, up from 450 a year ago, with plans to hire 25 to 35 people in the next six months.

“We don’t have it at 100 percent perfect yet,” Phillips-Henry said. “But we are all redesigning toward seeing people very quickly when they have a problem.”

At this point, financing the increases is not an issue. The centers receive payment from the government for every Medicaid-eligible person they see. The federal government will pay for 100 percent of the costs of Medicaid expansion from 2014 to 2016, then 90 percent to 2020.

Inpatient beds in short supply

Scott Glaser

Scott Glaser

Scott Glaser, executive director of NAMI Colorado, said a larger problem with providing services for the increased numbers lies with people who require long-term hospitalization. “Colorado does not have an adequate supply of long-term psychiatric beds,” Glaser said.

Some hospitals are planning expansions to try to meet the need. Clear View Behavioral Health will open a new 90-bed facility in Johnstown in 2015, and Spanish Peaks Behavioral Health Centers in Pueblo is planning an expansion in about two years.

Phillips-Henry said the number of people who need “our highest levels of inpatient care is much higher since January. That really speaks to the fact that many of these folks really needed care and had no benefits before.”

And that’s the point, say mental health officials.

“The Medicaid expansion is really making an impact,” Glaser said. “More people have more coverage and more options. More people are seeking treatment. It’s moving us in the right direction.”

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