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CMS Data Shows Vulnerable Americans
Forgoing Mental Health Care During
COVID-19 Pandemic




Findings from New Data Analysis Correspond with Reports of
Adverse Mental Health Conditions for Vulnerable Populations

The Centers for Medicare & Medicaid Services (CMS) released data today
highlighting the continued impact the COVID-19 Public Health Emergency (PHE)
is having on Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries
and utilization of health services.  The data show that, from March through
October 2020, beneficiaries have foregone millions of primary, preventive, and
mental health care visits due to the COVID-19 PHE, compared to the same
time period in 2019. Although utilization rates for some treatments have
rebounded to pre-pandemic levels, mental health services show the slowest
rebound.

This decline in utilization is occurring at a time when preliminary evidence
shows mental health conditions have worsened nationwide. The gap in service
utilization due to the PHE, particularly for mental health services, may have
a substantial impact on long-term health outcomes. Medicaid and CHIP-funded
mental health services, in addition to primary and preventative services, cover
the majority of children, people living in poverty, and those with special health
care needs. Medicaid and CHIP also cover millions of racial and ethnic minorities.

To help close this gap in services, CMS is emphasizing mental health care in its
recently launched Connecting Kids to Coverage National Campaign, a national
outreach and enrollment initiative funded under the Children's Health Insurance
Program Reauthorization Act (CHIPRA) and the Affordable Care Act, that reaches
out to families with children and teens eligible for Medicaid and CHIP.

The Biden-Harris Administration is committed to achieving mental health parity,
expanding access to mental health care, and eliminating mental health stigmas.
In addition to improving access to mental health services provided to Medicaid
and CHIP beneficiaries, President Biden’s American Rescue Plan provided funding
to addresses our mental health and substance use challenges, including $3 billion
in funding for block grants to address mental health and substance use prevention,
treatment, and recovery services. This is alongside $1.4 billion to support the
mental health needs of health care professionals and first responders, as well as
funding specifically for pediatric mental health.             

“More than 100 million Americans, including 43 million children, relied on us to
deliver access to mental health and other services they needed through Medicaid
and CHIP in 2020. Medicaid is the largest payer in the nation for mental health and
that care is a lifeline for many,” said CMS Acting Administrator Liz Richter.
“This new data provides a window into the impacts of the pandemic for marginalized
communities – particularly children and other vulnerable people – and is critical as
we work towards meeting the needs of those that rely on Medicaid and CHIP.
While we’re encouraged that people are accessing some health care services at
pre-pandemic levels, there is work to do to connect people to mental health care
services and to ensure we fill the gap in other types of services that was caused
by the pandemic. The Centers for Medicare & Medicaid Services is committed
to connecting people and children to health care – including mental health care.”

Specifically, the results demonstrate a 34% decline in the number of mental health
services utilized by children under age 19, compared to the same time period in 2019,
and 22% decline in the number of mental health services utilized by adults aged
19 to 64, compared to the same time period in 2019. This translates to approximately
14 million fewer mental health services for children and approximately 12 million
fewer mental health services for adults, for a total of nearly 26 million fewer mental
health services utilized across both groups. Similarly, although there are preliminary
reports of increased drug-related mortality due to the COVID-19 PHE, substance use
disorder service utilization fell by 3.6 million services (13% decline) when compared
to the same time period in 2019.

It is important to note that the data does show that utilization rates for certain primary
and preventive services for children under age 19 have recovered to pre-pandemic
levels, or have started to rebound across many areas of the country. While this recovery
is encouraging, millions of services still need to be delivered to make up for those
missed between March and October 2020. Preliminary 2020 data shows 9% fewer
childhood vaccinations for beneficiaries under age two (1.8 million services),
21% fewer child screening services (4.6 million services) among children under
age 19, and 39% fewer dental services (11.4 million services) among children under
age 19 when compared to pre-pandemic levels. This data takes into account increases
in telehealth utilization of services via telehealth.

Throughout the pandemic, CMS has encouraged states to consider telehealth options
to combat COVID-19 and increase access to care. This updated data snapshot
demonstrates a marked increase in the number of services delivered via telehealth
compared to prior years. The number of services delivered via telehealth surged
2,700% during the PHE to nearly 68 million between March and October 2020.
However, this increase has not been enough to offset the decline in service utilization
in other areas.

For COVID-19 treatment and acute care use, the preliminary findings show more than
1.2 million Medicaid and CHIP beneficiaries received COVID-19 treatment, and nearly
124,000 were hospitalized through October 2020. Despite significant variance across
states regarding this data, preliminary results suggest that the COVID-19 treatment
rate increases with age. In addition, Medicaid and CHIP paid for nearly 10 million
COVID-19 tests or testing related services, although this data does not include tests
provided free of charge or covered by other insurance programs, including Medicare.

CMS will continue monitoring and working with states, providers and stakeholders to
develop and implement innovative ways to provide access to critical health care such
as preventive childhood vaccinations and mental health services to beneficiaries enrolled
in Medicaid and CHIP.

The data released today can be found here