Colorado Medicaid Boosts Mental Health Access in Primary Care
New Payment Model Funds Crucial Support Services
Colorado is expanding mental health and addiction treatment by allowing Medicaid to reimburse primary care offices for essential behind-the-scenes coordination. This initiative aims to connect more individuals with the care they desperately need.
Collaborative Care Model Takes Root
The embraced approach, known as the collaborative care model, integrates mental health professionals directly into primary care settings. Psychiatrists are available for consultations, often through telehealth, to guide patient treatment plans. This allows for more seamless and accessible mental healthcare integration.
Traditionally, insurance primarily covered direct patient treatment, overlooking the vital time spent by professionals in assessing, tracking progress, and coordinating care with specialists. Colorado’s decision to cover this supportive work, effective July 1st, marks a significant shift. It positions the state as the 36th to adopt such a policy, according to Path Forward.
The Colorado Department of Health Care Policy and Financing anticipates the change will cost the state’s general fund approximately $368,000 in its inaugural year, supported by about $1.1 million in federal matching funds. This financial support is expected to bolster the sustainability of offering these integrated services within practices.
“The ability to bill Medicaid for that work will make it more sustainable for primary care practices to bring at least some mental health services in-house,” stated **Dr. Shen Nagel** of Pediatrics West in Wheat Ridge. His practice currently employs a mental health professional, partially funded by grants.
Previously, primary care providers often referred patients to community mental health services, with no guarantee of follow-through. **Dr. Nagel** noted that his practice’s on-staff professional currently assists patients with less complex needs, but the new model will enable support for those requiring more intensive care, with psychiatrist consultation.
While referrals will still be necessary, this model offers children the comfort of receiving mental health support in a familiar environment. **Dr. Nagel** added, “We could probably fill the schedules of five to six behavioral health providers, easily.”
Expanding Reach and Improving Outcomes
The collaborative care model has seen limited adoption in Colorado thus far. In 2023, approximately 500 individuals received care under this model through commercial insurance, and 700 through Medicare in 2022, as per a Milliman report. Nationwide figures show around 125,000 people benefited from commercially insured collaborative care, with an additional 73,000 covered by Medicare or Medicaid.
Studies consistently indicate that patients with depression receiving collaborative care report better symptom improvement compared to those in standard primary care. One study noted similar gains in both groups, potentially reflecting varying levels of primary care provider capabilities.
Improvement rates reported by clinics vary, with some seeing one-third of patients experience reduced depression symptoms, while a Texas clinic reported improvement in four out of five patients. This highlights the model’s potential for significant positive impact.
The mental health community has keenly awaited this Medicaid billing approval, especially given anticipated budget challenges. “We’ve been waiting in Colorado for this day as long as I’ve been here,”
shared **Dr. K. Ron-Li Liaw**, Chief of Mental Health at Children’s Hospital Colorado. Most current collaborative care users are adults, but Colorado has an opportunity to demonstrate its benefits for the estimated 20% of pediatric patients with behavioral health needs.
A psychiatrist at Children’s Hospital Colorado is collaborating with six practices, including Pediatrics West, to tailor the model for pediatric care. This initiative promises to bridge a critical gap in accessible mental healthcare for young Coloradans.
The Centers for Disease Control and Prevention reports that approximately 1 in 5 children aged 3-17 in the U.S. have a diagnosed mental, emotional, or behavioral disorder. Expanding integrated care models is crucial to addressing this widespread need.