As North Carolina gears up for the long-awaited implementation of Medicaid expansion, the state is addressing a critical issue: ensuring that the expanded coverage translates into accessible and well-reimbursed mental health care services.
With the expansion set to provide health insurance to over 600,000 low-income residents, the state acknowledges the pressing need for mental health care, especially in the aftermath of the COVID-19 pandemic.
North Carolina DHHS Takes Bold Action
One significant hurdle has been the financial strain on behavioral health providers, particularly mental health practitioners, who often find themselves inadequately reimbursed for services covered by Medicaid.
This has led to a concerning exodus of providers from the program, hindering the delivery of essential mental health care. In response, the North Carolina Department of Health and Human Services (DHHS) has announced a pivotal step to address this issue.
For the first time since 2012, the minimum reimbursement rates for behavioral health care will see an increase, offering a more sustainable financial model for providers.
The newly announced rates, effective from January 1, 2023, are made possible by a $200 million allocation of recurring funds from the General Assembly. Kody Kinsley, head of DHHS, emphasizes the significance of this investment in the provider community.
He states, “It’s a huge investment in our provider community. It’s a huge investment in increasing the amount of provider workforce, and it’s going to open up the tap and access for people who so desperately need it.”
The fee schedule adjustments will apply to most Medicaid-covered treatments for mental health and substance use disorder, intellectual and developmental disabilities, and services for patients with traumatic brain injury.
The rate increases are expected to be permanent, providing a more stable foundation for behavioral health providers.
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North Carolina’s Medicaid Reimbursement Overhaul
State Senator Sydney Batch underscores the importance of addressing low reimbursement rates, stating that many therapists have refrained from practicing due to these financial challenges.
The disparities between physical health and behavioral health services reimbursement have been a long-standing concern, and these adjustments aim to bridge that gap.
Among the notable changes, facilities providing inpatient psychiatric care will see a significant boost in reimbursement, from less than $500 a day to nearly $900.
The overall reimbursement for inpatient psychiatric care is projected to increase by 30 percent, marking a substantial improvement.
The announcement of rate adjustments comes ahead of the anticipated surge in Medicaid enrollment in North Carolina, scheduled for December 1. The income limit for eligibility will increase to 138 percent of the federal poverty level, making more residents eligible for coverage.
While the state expects a surge in enrollment, Kinsley acknowledges the challenges of managing the increased demand, likening it to a new product launch with a rush of interest.
Despite the potential initial challenges, the focus is on sustaining the momentum and ensuring that eligible individuals continue to enroll in the Medicaid expansion benefit, recognizing the critical role it plays in supporting working families and individuals in need of mental health care.
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