CLOSING MENTAL HEALTH TREATMENT DESERTS: WHY MEDICAID RATE INCREASES ALONE FALL SHORT AND WHICH POLICIES EXPAND ACCESS
Author(s)
MEHMET SARI, PhD.
Economics, Abdullah Gul University, Kayseri, Turkey.
Economics, Abdullah Gul University, Kayseri, Turkey.
OBJECTIVES: Most people who need mental health care do not receive it, and over 120 million Americans live in designated shortage areas. Many states are raising Medicaid behavioral health reimbursement rates as their primary tool to attract providers and expand access. We assess whether rate increases actually expand the provider workforce, and identify which policy combinations most improve population-level treatment access.
METHODS: Using one of the largest recent US rate increases, which is Oregon's 30% Medicaid behavioral health rate rise (July 2022), and national provider enumeration data (NPPES), we measure new mental health provider entry with synthetic control and difference-in-differences over 45 months. We then build a structural model of treatment access with three behavioral margins (patient treatment-seeking, provider entry, and Medicaid participation) to quantify how alternative policies translate into population treatment rates and patients treated.
RESULTS: Oregon's rate increase produced no detectable increase in new provider entry (−1.05%; 95% prediction interval −28.3% to +11.8%), a result robust across specifications and placebo tests. Translating this into access, rate increases alone raise the national treatment rate by only about 0.3 percentage points. By contrast, a policy portfolio combining telehealth expansion, scope-of-practice reform, insurance expansion, and targeted rate increases raises the national treatment rate from 51% to 61% that accounts for an additional 7.1 million adults treated annually. The binding constraints are training-pipeline capacity, licensure barriers, and provider geographic preferences, not reimbursement alone.
CONCLUSIONS: Rate adequacy is necessary but not sufficient to close mental health treatment deserts. Decision-makers and payers should pair reimbursement reform with non-price interventions(telehealth, scope-of-practice expansion, insurance coverage, and training-pipeline investment) to achieve meaningful gains in mental health treatment access.
METHODS: Using one of the largest recent US rate increases, which is Oregon's 30% Medicaid behavioral health rate rise (July 2022), and national provider enumeration data (NPPES), we measure new mental health provider entry with synthetic control and difference-in-differences over 45 months. We then build a structural model of treatment access with three behavioral margins (patient treatment-seeking, provider entry, and Medicaid participation) to quantify how alternative policies translate into population treatment rates and patients treated.
RESULTS: Oregon's rate increase produced no detectable increase in new provider entry (−1.05%; 95% prediction interval −28.3% to +11.8%), a result robust across specifications and placebo tests. Translating this into access, rate increases alone raise the national treatment rate by only about 0.3 percentage points. By contrast, a policy portfolio combining telehealth expansion, scope-of-practice reform, insurance expansion, and targeted rate increases raises the national treatment rate from 51% to 61% that accounts for an additional 7.1 million adults treated annually. The binding constraints are training-pipeline capacity, licensure barriers, and provider geographic preferences, not reimbursement alone.
CONCLUSIONS: Rate adequacy is necessary but not sufficient to close mental health treatment deserts. Decision-makers and payers should pair reimbursement reform with non-price interventions(telehealth, scope-of-practice expansion, insurance coverage, and training-pipeline investment) to achieve meaningful gains in mental health treatment access.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HPR229
Topic
Epidemiology & Public Health, Health Policy & Regulatory, Health Service Delivery & Process of Care
Topic Subcategory
Health Disparities & Equity, Reimbursement & Access Policy
Disease
Mental Health (including addiction)