1. Behavioral Health: Can Primary Care Help Meet the Growing Need? Deanna Okrent Alliance for Health Reform www.allhealth.org May 4, 2012

2. Background  Current need in U. S.  Is the need being met?  How is behavioral health care financed?  Policy questions

3. Who needs behavioral health services?  Current need Nearly half of all Americans will develop a mental illness in their lifetime 27% of Americans will have a substance use disorder in their lifetimes In 2009, mental health conditions were the fourth most common reason for hospital admission among children In 2007, nearly 1/3 of adults and 1/5 of children had a behavioral health problem  Dually-eligible beneficiaries report the highest rates of mental illness 50% among disabled beneficiaries 20% among aged beneficiaries

4. Is the need being met?  Behavioral health services have increased, but 60% of adults with a mental health disorder do not receive treatment  In 2011, 17 % of adults had co-morbid mental health and medical conditions 70% of children who need services do not receive treatment  The average time between onset and treatment of mental illness in children is nine years

5. Mental Health Financing  Medicaid is the largest single source of payment Covers over 25% of all expenditures Covers a broad range of benefits  Medicare covers 7% More limited range of benefits  Other public funds – state and local  Private insurance Covers high % of population but less than 25% of expenditures

6. Policy Questions  Integrating behavioral and physical health – do current models hold promise?  Are there enough providers now? For 2014 and later?  What is needed to help primary care fill the gap?  Can states meet the budgetary challenge in Medicaid programs?  How are CMS, HRSA, and SAMHSA supporting innovations as provided for in the health reform law?  Is parity being implemented per the Mental Health Parity and Addictions Equity Act?  Institutional care vs home health/outpatient care– what will the future hold?