Opting Out of Medicaid Expansion: Impact on Encounters With Behavioral Health Specialty Staff in Community Health Centers.
OBJECTIVE
This study examined how state decisions not to expand Medicaid have affected behavioral health services utilization in health centers. Because health center revenues are adversely affected, the ability to provide on-site nonrequired services, such as specialty mental health and substance abuse treatment services, is compromised.


METHODS
Using 2012 Uniform Data System data and the projected health center insurance case mix in 2020, the authors estimated the amount of additional revenue that could accrue to health centers if all states were to expand Medicaid by 2020. Using the estimated percentage of total revenues supporting the provision of specialty behavioral treatment services, the authors also estimated the number of encounters with behavioral health specialists that might be possible in 2020 if all states expand Medicaid by then. State-specific estimates are provided.


RESULTS
If all states expand Medicaid by 2020, it is estimated that nearly $230 million in additional revenue could accrue to health centers in states that opted out of expanding Medicaid in 2014. An estimated $11.3 million would likely be used for mental health services and $1.6 million might be used to provide substance use disorder services. This translates to over 70,500 additional encounters that could occur with behavioral health specialists if all states expand Medicaid by 2020.


CONCLUSIONS
On-site behavioral health services are needed in health centers. However, financial constraints might limit the ability of health centers to provide on-site behavioral health services, particularly in states opting out of Medicaid expansion.
Dr. Jones is with the Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services (DHHS), Washington, D.C. (e-mail: emily.jones@hhs.gov ). She is also with the Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, D.C., where Dr. Zur, Ms. Rosenbaum, and Dr. Ku are affiliated.
Emily
E
Jones
Dr. Jones is with the Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services (DHHS), Washington, D.C. (e-mail: emily.jones@hhs.gov ). She is also with the Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, D.C., where Dr. Zur, Ms. Rosenbaum, and Dr. Ku are affiliated.
Julia
J
Zur
Dr. Jones is with the Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services (DHHS), Washington, D.C. (e-mail: emily.jones@hhs.gov ). She is also with the Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, D.C., where Dr. Zur, Ms. Rosenbaum, and Dr. Ku are affiliated.
Sara
S
Rosenbaum
Dr. Jones is with the Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services (DHHS), Washington, D.C. (e-mail: emily.jones@hhs.gov ). She is also with the Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, D.C., where Dr. Zur, Ms. Rosenbaum, and Dr. Ku are affiliated.
Leighton
L
Ku
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003151:Community Health Centers / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D013219:State Government; D013221:State Health Plans / Q000706:statistics & numerical data*; D014481:United States; D055815:Young Adult