Medicaid Program Survey: States Implementing Strategies to Address Worker Shortage

In an effort to attract or retain Medicaid behavioral healthcare professionals, at least 28 states either implemented fee-for-service rate increases in fiscal year 2022 or plan to do so in 2023, according to data released recently by the Kaiser Family Foundation (KFF).

A KFF survey received responses from 44 states and Washington, D.C. Of the responding states, 19 reported rate increases in 2022, and 23 said they plan to increase their rates in 2023. Meanwhile, 16 states reported no rate increases for 2022 or 2023. In some states, rate increases were implemented for specific provider types, such as residential substance use disorder treatment providers or applied behavior analysts, while other states took a more widespread approach. KFF cited Oregon as an example of the latter, noting the state directed a 30% increase for behavioral healthcare providers who receive at least 50% of their revenue from Medicaid and a 15% increase for providers who receive less than 50% from Medicaid.

The rate increases are 1 of 4 areas of focus identified by KFF to address behavioral health workforce shortages. Nearly all states reported to KFF that they are using at least 1 specified strategy to increase the workforce with nearly half of responding states endorsing at least 1 strategy in all 4 areas. Besides rate increases, strategies are being developed for the following areas:

Extending the workforce. Nearly all responding states indicated that they have at least 1 strategy in place or in the planning stages to expand the behavioral healthcare workforce. Strategies include extending the types of providers who could bill for services, using inter-professional consultation codes, and engaging in outreach efforts to recruit new providers. Telehealth is another option for addressing workforce shortages, as states “have broad authority to cover telehealth in Medicaid without federal approval,” KFF noted in its report.

Reducing administrative burden. About 75% of responding states said they either have a strategy in place or are planning one for 2023 to reduce administrative activities both in fee-for-service and/or managed care organizations. Administrative activities can include prior authorization, documentation requirements, and credentialing. KFF said the survey responses it received from states indicate a growing number are planning to implement centralized or standardized credentialing in 2023.

Incentivizing participation. With previous research showing that delays in reimbursement have caused reduced provider participation in Medicaid, about two-thirds of states told KFF they had prompt payment policies in place in 2022 or planned to implement them for 2023. Less than one-fifth of states, however, reported offering financial incentives for participating in integrated physical and behavioral health systems.

The full issue brief on strategies to address behavioral healthcare workforce shortages is available on the KFF website.

Reference

Saunders H, Guth M, Eckart G. A look at strategies to address behavioral health workforce shortages: findings from a survey of state Medicaid programs. Kaiser Family Foundation. Published online January 10, 2023. Accessed January 18, 2023.