Medicaid and CHIP data show a marked decrease in behavioral healthcare utilization amid the COVID-19 pandemic

Healthcare utilization plummeted during a long stretch of 2020, and arguably the biggest impact was seen in mental health services.

CMS released new data that illustrate the toll of the COVID-19 pandemic on healthcare utilization for Medicaid and Children’s Health Insurance Program beneficiaries.

For the period spanning March 2020 to October 2020, relative to the same time frame in 2019, significant decreases in utilization were seen. In beneficiaries ages 18 and younger, declines included:

• 1.8 million (9%) fewer vaccinations for beneficiaries younger than 2
• 4.6 million (21%) fewer child screening services
• 14 million (34%) fewer mental health services
• 11.9 million (39%) fewer dental services

Arguably the most notable trend was in mental health services. In addition to the decrease in pediatric services, CMS reported a drop of 12 million (22%) in such services for adults.

“The gap in service utilization due to the PHE [public health emergency], particularly for mental health services, may have a substantial impact on long-term health outcomes,” CMS stated in a news release.

In addition, utilization of substance-use disorder (SUD) services dropped by 3.6 million (13%).

In a May 18 national stakeholder call, an official with CMS’s Center for Medicaid and CHIP Services said the decrease in mental health services stood out from other trends in that it could be seen across states. In other categories, there was more variation from one state to the next.

Utilization declines while the need for services rises

The utilization trends particularly are a concern given the impact of the pandemic on mental health. Preliminary government data “suggests a sharp increase in the number of adults reporting adverse mental or behavioral health conditions during the COVID-19 pandemic compared to prior years,” CMS reported. The trend appears to be especially acute among racial and ethnic minority groups.

Preliminary evidence likewise “indicates an increase in drug-related mortality” during the pandemic.

Medicaid and CHIP together are the largest payer of mental health and SUD services. A quarter of beneficiaries receive such services even as barriers have been apparent since long before the pandemic.

Although telehealth represents an alternative mode of care for mental health services, it can’t close the gap completely. “For some of these services, they really cannot be delivered via telehealth. They have to be delivered in person,” the CMS official said. “That poses a unique challenge for the delivery of care during the public health emergency.”

For example, SUD services often are delivered in inpatient or partial-hospitalization settings.

Some positive utilization trends seen

Among beneficiaries younger than 19, utilization rates for some primary and preventive care services have recovered to pre-pandemic levels or at least are on the upswing, CMS reported.

Nevertheless, “millions of services still need to be delivered to make up for those missed between March and October 2020,” CMS stated in a news release.

Telehealth helped close some of the gap. The increase in telehealth services from March-October 2019 to the same period in 2020 was 2,700%, equating to almost 68 million additional services provided to Medicaid and CHIP beneficiaries.

Note about the methodology

CMS notes that its data should be interpreted “with caution.” The data are based on claims that can have a lag time of seven months at any given point and even longer during the pandemic. The delay “may impact the accuracy of the results.”