Assessment of Behavioral Health Services Use Among Low-Income Medicare Beneficiaries After Reductions in Coinsurance Fees

Coverage Parity And Racial And Ethnic Disparities In Mental Health And Substance Use Care Among Medicare Beneficiaries

Many older Americans do not receive needed care for mental health and substance use disorders (MHSUD), and there are substantial racial and ethnic disparities in receipt of this care across the lifespan. Medicare introduced cost-sharing parity for outpatient MHSUD care during the period 2010-14, reducing beneficiaries' out-of-pocket share of MHSUD spending from 50 percent to 20 percent. Among traditional Medicare beneficiaries ages sixty-five and older, we examined changes in MHSUD use and spending during the period 2008-18 for low-income beneficiaries with the cost-sharing reduction versus a control group of beneficiaries with free care throughout the study period among Black, Hispanic, Asian, and American Indian/Alaska Native versus White beneficiaries. Among older Medicare beneficiaries, overall use of MHSUD services increased during this period. For White beneficiaries, MHSUD cost-sharing parity was associated with an increased likelihood of having specialty MHSUD visits and medication use and a reduced likelihood of having unmonitored MHSUD medication use and MHSUD emergency department visits and hospitalizations. However, cost-sharing parity was associated with smaller or no gains in MHSUD services use for racial and ethnic minority beneficiaries compared with White beneficiaries, thus widening racial and ethnic disparities in MHSUD care.

Characteristics of Mental Health and Substance Use Service Facilities for Older Adults: Findings from U.S. National Surveys

OBJECTIVES

To describe the characteristics of U.S. mental health and substance use service programs dedicated/tailored for older adults (age 65+).

METHODS

Data came from the 2012 and 2019 National Mental Health Services Survey (N-MHSS) and the National Survey of Substance Abuse Treatment Services (N-SSATS). Using Pearson χ2 and Fisher's exact tests, we compared the numbers/proportions of older-adult programs in 2012 and 2019 and examined differences between facilities with or without an older-adult program in 2019.

RESULTS

From 2012 to 2019, the percent of all mental health and substance use service facilities for adults that had a dedicated/tailored program for older adults increased significantly, from 20.7% to 28.9% for mental health facilities and from 7.1% to 24.8% for substance use facilities, with 101 mental health facilities and 53 substance use facilities serving older adults exclusively in 2019. Compared to facilities without an older-adult program, higher percentages of facilities with such a program offered treatment for co-occurring mental and substance use disorders and supplemental health and social care services.

CONCLUSIONS

Given the rapidly aging society, more accessible and affordable programs dedicated/tailored for older adults are needed. To achieve this goal and better meet older adults' needs, more detailed data on facility characteristics are needed to build the knowledge base on improving the treatment environment.

CLINICAL IMPLICATIONS

Programs for older adults should be designed to meet the complex needs of those with mental health and/or substance use problems and incorporate innovative service delivery models that can improve older adults' access.