The mental healthcare landscape in Nebraska is being upended by policies for reimbursing providers who see patients covered by both Medicare and Medicaid. Systems say they're losing money, resulting in access gaps for older low-income clients.
Providers say the key concern has to do with serving patients considered dual-eligible, meaning they're enrolled in Medicare and Medicaid. This year, the federal government expanded the scope of professionals who can see Medicare patients for therapy and be reimbursed.
But Jon Day, executive director of Blue Valley Behavioral Health, said because of how Nebraska policy aligns with dual-eligible situations, practitioners are now seeing rates cut in half.
"More providers are coming out and saying, 'Oh my gosh, we can't see these people cause we're losing money.' So, we either refer them out, or they're not taking on people as well," he explained.
Day estimates a $200,000 revenue loss for his system and added that it's not easy to refer clients elsewhere because of provider "deserts" in some areas. Those working with the Nebraska Assocation of Behavioral Health Organizations have been meeting with state Medicaid leaders, noting the state can cover the difference without taking on extra costs. But progress on a final solution has been slow.
Providers say they understand the federal government's desire to bring more mental health professionals to the table in seeing patients. But they add unintended consequences at the state level almost defeat the purpose.
Chase Francl, CEO and president of the Mid-Plains Center for Behavioral Healthcare Services, said this is a heartbreaking situation.
"There's such a low margin on any behavioral health services, and any small disruption really can have catastrophic effects," he said.
Even though fixes offered by these providers are described as solutions without extra costs, they acknowledge the challenging environment given the appetite among elected officials to reduce the state's budget. As for the federal change that brought this situation to light, Licensed Independent Mental Health Practitioners can now be reimbursed under Medicare, and not just those with Masters or doctoral degrees in Social Work.
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An Atlanta-based group is making sure more people have access to an unconventional but effective treatment for their moderate mental health challenges: art.
It is estimated 1.8 million adults in Georgia live with some form of mental illness. The group Art Pharmacy partners with health care providers and community organizations to integrate creative activities into treatment plans.
Chris Appleton, founder and CEO of Art Pharmacy, said the approach, known as "social prescribing," connects people to arts and cultural experiences as a way to combat the mental health crisis and loneliness epidemic in the U.S.
"People get prescriptions to go to dance classes," Appleton outlined. "People get prescriptions to go on a guided tour at a museum. People get prescriptions to go to a ceramics workshop, or maybe a visit to your local botanical gardens."
In Georgia, Art Pharmacy partners with school-based behavioral health clinics to support young people struggling with anxiety and depression. It is also working with Medicaid health plans to assist at-risk youth with serious emotional disturbances, and helping older adults at risk of social isolation.
Appleton stressed Art Pharmacy is not meant to replace psychotherapy, especially for those who need psychiatric care, but it is another option for those with mild to moderate concerns. He added through care navigators, people are connected to creative activities that keep them engaged in treatment, offering a different path to improving their mental well-being while reducing stigma.
"There's an acknowledgment that new forms of care are required to make progress on these struggles," Appleton asserted. "I think a second piece is that while stigma around mental health has improved in the U.S. over the past several years -- especially among younger generations -- many people still struggle to raise their hand and say, 'I need help.'"
He added Art Pharmacy keeps track of progress using mental health and well-being assessments. While there are challenges in making social prescribing a standard part of health care, he believes it is only a matter of time before the approach becomes a go-to option alongside traditional treatments.
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As winter drags on with a recent rare burst of snow across North Florida, many Floridians struggle with seasonal affective disorder.
It is a form of depression triggered by shorter days and less sunlight. Mental health professionals across the state are offering practical strategies to help people cope, emphasizing the importance of light exposure, social engagement and seeking professional support.
Judy Charuhas, clinical director of outpatient services for Impower, a Florida-based telehealth provider, said simple acts of kindness can boost a person's mood and emotional well-being.
"Melatonin helps us feel better. Serotonin, endorphins -- when your endorphins get going -- you feel better," Charuhas outlined. "One thing people can do with depression that helps more than anything else is do something for someone else."
A recent study showed 40% of Americans say their mood drops in the winter, 41% are sleeping more, 28% feel fatigued and 27% report experiencing depression.
Lourdes Araujo, president of the Florida Counseling Association, recommended a light therapy box, which mimics sunlight exposure, for those experiencing symptoms.
"If the sunlight goes away, you can extend that time by using this sunlight exposure approach," Araujo explained. "It's really proven to be helpful with depressive symptoms."
She also encouraged cognitive behavioral therapy techniques to challenge negative thoughts and set realistic goals.
Dr. Rhonda Randall, chief medical officer and executive vice president of UnitedHealthcare Employer and Individual, stressed the importance of maintaining social connections and leveraging available mental health resources.
"People who have strong social connections actually live longer," Randall pointed out. "When we think about longevity and quality of life, those strong ties to friends and family are very good to our health."
Randall added many insurance plans offer mental health benefits such as virtual therapy, coaching and digital self-help tools, which can be convenient options for those who struggle during the winter months.
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Some 125,000 children in Michigan struggle with major depression, which can hinder learning, behavior and relationships, according to a recent survey. Research shows the benefits of school-based services to connect them with the care they need.
Together with parents, school mental health resources can help keep kids safe.
Scott Hutchins, who manages the behavioral health unit for the Michigan Department of Education, stresses the importance of these services, especially in light of the pandemic and school shootings.
"Those needs have only been exacerbated since COVID and those other violent tragedies," he said. "So, what mental-health services do is, they allow us to break down the barriers that students need to get the care that they need."
However, the state needs more of these professionals. Michigan has one school psychologist per almost 2,200 students. The recommended ratio is one for every 500 students. The state also requires school districts to include suicide-prevention hotline contact information on IDs for students in grades 7 through 12.
Statistics show youths receiving school-based mental-health services are six times more likely to complete treatment than those receiving community-based services.
Angela Kimball, chief advocacy officer for the nonprofit mental health advocacy group Inseparable, noted that funding is one key challenge in expanding the school mental-health workforce.
"In order to become a licensed professional," she said, "you not only have to pay for schooling, but there's also periods of supervision - where people are essentially working for free and having to pay for supervision as they work towards their credentials."
Kimball said groups like hers are pushing for policies to improve staff ratios and encourage people to consider mental-health careers. In the meantime, if you or someone you know is in crisis, call 988 to be connected with a trained counselor, available 24/7.
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