CMS data shows children, adults forgoing mental healthcare during pandemic

May 17, 2021

The Centers for Medicare & Medicaid Services (CMS) released data highlighting the continued impact the COVID-19 Public Health Emergency (PHE) is having on Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries and utilization of health services, showing a decline in healthcare visits.

The data show that, from March through October 2020, beneficiaries have foregone millions of primary, preventive, and mental healthcare visits due to the COVID-19 PHE, compared to the same time period in 2019. Although utilization rates for some treatments have rebounded to pre-pandemic levels, mental health services show the slowest rebound. This decline in utilization is occurring at a time when preliminary evidence shows mental health conditions have worsened nationwide. The gap in service utilization due to the PHE, particularly for mental health services, may have a substantial impact on long-term health outcomes.

Medicaid and CHIP-funded mental health services, in addition to primary and preventative services, cover the majority of children, people living in poverty, and those with special healthcare needs. Medicaid and CHIP also cover millions of racial and ethnic minorities. To help close this gap in services, CMS is emphasizing mental healthcare in its recently launched Connecting Kids to Coverage National Campaign, a national outreach and enrollment initiative funded under the Children's Health Insurance Program Reauthorization Act (CHIPRA) and the Affordable Care Act, that reaches out to families with children and teens eligible for Medicaid and CHIP.

In addition to improving access to mental health services provided to Medicaid and CHIP beneficiaries, President Biden’s American Rescue Plan provided funding to addresses our mental health and substance use challenges, including $3 billion in funding for block grants to address mental health and substance use prevention, treatment, and recovery services. This is alongside $1.4 billion to support the mental health needs of healthcare professionals and first responders, as well as funding specifically for pediatric mental health. More than 100 million Americans, including 43 million children, relied on us to deliver access to mental health and other services they needed through Medicaid and CHIP in 2020. Medicaid is the largest payer in the nation for mental health and that care is a lifeline for many,” said CMS Acting Administrator Liz Richter.

Specifically, the results demonstrate a 34% decline in the number of mental health services utilized by children under age 19, compared to the same time period in 2019, and 22% decline in the number of mental health services utilized by adults aged 19 to 64, compared to the same time period in 2019. This translates to approximately 14 million fewer mental health services for children and approximately 12 million fewer mental health services for adults, for a total of nearly 26 million fewer mental health services utilized across both groups. Similarly, although there are preliminary reports of increased drug-related mortality due to the COVID-19 PHE, substance use disorder service utilization fell by 3.6 million services (13% decline) when compared to the same time period in 2019.

It is important to note that the data does show that utilization rates for certain primary and preventive services for children under age 19 have recovered to pre-pandemic levels or have started to rebound across many areas of the country. While this recovery is encouraging, millions of services still need to be delivered to make up for those missed between March and October 2020. Preliminary 2020 data shows 9% fewer childhood vaccinations for beneficiaries under age two (1.8 million services), 21% fewer child screening services (4.6 million services) among children under age 19, and 39% fewer dental services (11.4 million services) among children under age 19 when compared to pre-pandemic levels. This data takes into account increases in telehealth utilization of services via telehealth.

This updated data snapshot demonstrates a marked increase in the number of services delivered via telehealth compared to prior years. The number of services delivered via telehealth surged 2,700% during the PHE to nearly 68 million between March and October 2020. However, this increase has not been enough to offset the decline in service utilization in other areas.

For COVID-19 treatment and acute care use, the preliminary findings show more than 1.2 million Medicaid and CHIP beneficiaries received COVID-19 treatment, and nearly 124,000 were hospitalized through October 2020. Despite significant variance across states regarding this data, preliminary results suggest that the COVID-19 treatment rate increases with age. In addition, Medicaid and CHIP paid for nearly 10 million COVID-19 tests or testing related services, although this data does not include tests provided free of charge or covered by other insurance programs, including Medicare.

CMS will continue monitoring and working with states, providers and stakeholders to develop and implement innovative ways to provide access to critical health care such as preventive childhood vaccinations and mental health services to beneficiaries enrolled in Medicaid and CHIP.

CMS has the fact sheet.