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For People With Opioid Addiction, Medicaid ‘Unwinding’ Raises the Stakes

November 18, 2024

As of September, more than 25 million Americans — including 1.9 million Floridians — had lost Medicaid coverage since the expiration of federal covid-19 pandemic protections in March 2023 that had kept people continually enrolled. Among them were patients in treatment for opioid addiction, such as Stephanie, for whom a loss of coverage could be deadly.

Research shows that, when taken as prescribed, medications for opioid use disorder — such as methadone and a similar medicine, buprenorphine — can reduce dangerous drug use and cut overdose fatalities by more than half. Other studies have found the risk of overdose and death increases when treatment is interrupted.

It is unclear how many people with opioid addiction have lost coverage in the Medicaid disenrollment, known as the “unwinding.” But researchers at KFF, a health information nonprofit that includes KFF Health News, estimate that more than 1 million low-income Americans depend on the federal-state Medicaid program for lifesaving addiction care.

Methadone and buprenorphine are considered the gold standard of care for opioid addiction. The drugs work by binding to the brain’s opioid receptors to block cravings and withdrawal symptoms without making a person feel high. Treatment reduces illicit drug use and the accompanying overdose risk.

However, few Americans who could benefit from the medicines actually receive them: The latest federal data shows that in 2021 only about 1 in 5 people who needed the medicines got them. The low numbers offer a sharp contrast to the record-high drug overdose epidemic, which killed nearly 108,000 Americans in 2022 and is driven primarily by opioids.

Even before the Medicaid unwinding, about 13% of people younger than 65 in Florida were uninsured, one of the highest rates in the country, according to census data. Florida is also one of 10 states that have not expanded Medicaid for low-income adults.

Canceled Appointments, Unexplained Mixups – Veterans Facing Challenges Getting VA Mental Health Care

November 15, 2024

The Department of Veterans Affairs actively encourages veterans to enroll in VA health care, and officials, including VA Secretary Denis McDonough, voice pride in the department’s expertise treating combat-related mental health conditions. In 2023 alone, nearly 11% of the nation’s 18.1 million veterans sought mental health services at the VA, having 19.6 million behavioral health “encounters” with the VA, including appointments, walk-ins and emergency room visits.

But veterans say they often can’t get individual therapy appointments to accompany psychiatric medical care, and when they do connect, the treatment often is derailed by appointment cancellations and scheduling problems, according to more than a dozen veterans and current and former VA employees interviewed by Military.com.

They shared remarkably similar stories of working up the courage to seek help — something that historically has not been easy in a community skeptical of mental health treatment — and waiting months for sessions as multiple appointments were canceled, either at the start of a telehealth session or on arrival at a medical center or clinic.

Data provided by the VA showed that from 2020 through 2023, the cancellation rate for mental health appointments across facilities averaged 10.6%, with a high of 12.1% in 2020 early in the COVID-19 pandemic to 9.2% in 2023.

But individual medical centers may have bigger issues. Data obtained by the Americans for Prosperity Foundation through an ongoing Freedom of Information Act lawsuit showed that at 14 representative facilities across the U.S., from January 2020 to late May 2021, the cancellation rate was nearly double the VA provided figures, at 21%, although the time frame coincided with the height of the COVID-19 pandemic restrictions on non-urgent care.

Theories on the causes of cancellations vary. VA employees who spoke with Military.com said provider shortages are the root cause, while others point to the lack of a centralized scheduling system or pressure to keep veteran care inside the walls of a VA facility.

The VA has 32,199 mental health workers, including psychiatrists, psychologists, licensed professional mental health counselors, marriage and family therapists, peer support specialists, nurses and physician assistants, on staff, and officials say they are hiring more.

But the VA struggles to recruit clinicians, especially to rural locales and areas with underserved populations, and it competes with the private sector, where, in many places, quality care commands cash-only payments. According to the VA Inspector General in September, 66 of the VA’s 140 health systems reported severe shortages of psychiatric providers.

VA officials said patient requests for mental health care have grown steadily in the past 10 years at a rate that far exceeds demand for overall health services, and they have shifted toward a more proactive approach that includes case management, outreach and “stepped-care,” meaning it may begin a patient with group therapy, self-help or brief sessions and proceed to more intensive treatment as needed.

The VA also has hired more mental health providers — including 4,106 last year.

U.S. Migration Surge Draws Attention to Mental Health Care

November 13, 2024

The arrival of nearly 215,000 migrants into New York City since the spring of 2022 has placed significant demands on mental health service agencies and community organizations that were already stretched thin by COVID-19. A study led by researchers at the City University of New York (CUNY), for example, found that rates of mental health problems among Harlem residents were two to three times higher in 2021 than they were before the pandemic, people living in low-income housing facing twice as many barriers to health care than those living in market-rate housing.

NYC Health + Hospitals responded to the influx of asylum seekers by opening an arrival center in May 2023 as part of Mayor Eric Adam’s Blueprint to Address New York City’s Response to the Asylum Seeker Crisis. Based in the Roosevelt Hotel in Midtown Manhattan, it provided medical, social, and resettlement services to nearly 150,000 people from more than 160 countries in its first year. Additionally, arrival center staff have used the patient health questionnaire to screen more than 130,000 migrants age 12 and older for depression since May 2024, those showing symptoms being then further assessed and provided with referrals to necessary care.

Harlem Strong and ENGAGE are two New York City–based efforts that are bringing people together and adapting models originally developed to provide mental health services to people in low- or middle-income countries for use in an urban context.

Harlem Strong is a collaboration led by the CUNY Center for Innovation in Mental Health, Harlem Congregations for Community Improvement, Harlem Health Initiative, and Healthfirst Managed Care, the state’s largest nonprofit health insurer. ENGAGE partners Columbia University Irving Medical Center’s Department of Psychiatry, the New York State Office of Mental Health, and three community-based organizations: Acacia Network, S:US (Services for the Underserved), and African Services Committee.

Both efforts train non–health-care staff at community-based organizations to identify people with behavioral health needs and either provide or refer them to necessary services.

Food Insecurity and Mental Health Crisis Among Concerns for Latino College Students

November 11, 2024

Latino college students face significant barriers across the United States, according to UnidosUS, the largest Latino civil rights and advocacy organization who released a new national survey on Tuesday. Among the 3,000 Hispanic students between the ages of 18 and 35 surveyed, the study highlighted systemic and institutional obstacles that these students face while navigating higher education.

The UnidosUS survey was conducted by BSP Research, an independent national survey company, between Aug. 16 and Sept. 25, 2024. All respondents completed the survey online and it was available in English and Spanish.

One of the key findings of the study is that Latino students are aspirational, viewing college as a gateway toward better paying jobs and a way to provide a better life for their families. However, a staggering 85 percent of Latino students said they struggle with food insecurity. These challenges were consistent across those enrolled at two-year colleges and four-year institutions. Among the Latino students who faced food insecurity, 45 percent of students sought access through Supplemental Nutrition Assistance Program (SNAP) benefits.

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Survey: Food Insecurity and Mental Health Crisis Among Concerns for Latino College Students
Angela Dennis
Oct 22, 2024

“Each year nearly one million Latino students turn 18 years of age and graduate from high school. Most aspire to go to college, knowing that higher education is a key that unlocks the door to a better and more enriching life,” said Eric Rodriguez, senior vice president of policy and advocacy at UnidosUS. “But too many find that college is no escape from the struggle against poverty and food insecurity. We must invest in supporting these students to ensure that higher education can deliver on its promise.”

Rodriguez said that it was critically important to create opportunities for Latinos—who now make up one in five students at the postsecondary level—to thrive in college.

According to the survey, 72% of Latino students said that they worry that the U.S. Supreme Court’s ruling on affirmative action could lead to a decrease in the number of Latinx students being admitted into college. Additionally, a number of students, particularly those from low-income backgrounds, admitted to experiencing feelings of isolation while on campus.

A bright spot of the survey indicated that 84% of students surveyed felt a sense of belonging while on campus, while 24 percent of students who dropped out mentioned a lack of belonging as a contributing factor. Notably, students from lower-income backgrounds were more inclined to feel like outsiders. The study also highlighted that over half of the students, (53 %) noticed the presence of free-speech and diversity programs on campus, while nearly half (47%) observed restrictions on topics in classes. About two-thirds (66%) of Latino students considered leaving college at some point, with one-third (34%) saying they had to take a leave of absence for a variety of reasons.

Asian Health Center Tries Unconventional Approach to Counseling

November 6, 2024

In her first months as a community health worker, Jee Hyo Kim helped violent crime survivors access supportive services and resources. When a client with post-traumatic stress disorder sought a therapist, she linked him to one that fit his needs. She helped clients afraid to leave their homes obtain food delivery vouchers. As one client described her, Kim was a “connector.”

Then, Kim learned to go further. Through a training program, she gained the know-how and confidence to provide emotional support. She learned evidence-based mental health counseling skills such as asking open-ended questions. She also discovered that some things she was already doing, such as listening attentively and restating what she hears, are core to communicating empathy — a vital component of a successful relationship between a client and their mental health provider.

Asian Health Services, where Kim works, is a part of a fledgling movement trying to address a dire shortage of therapists by training community health workers and other nonlicensed professionals who have trusted relationships with their communities to add mental health counseling to their roles. This approach, already implemented abroad and proven to help address some common mental health conditions, is called lay counseling.

The Oakland-based community health center serves mostly low-income Asian immigrants who speak limited English. As a community health worker, Kim now also practices lay counseling under a licensed therapist’s supervision. She does not have a license, but as a Korean immigrant and strong-arm robbery survivor, she shares lived experiences with many of the people she serves, enabling her to build trust.

Concerned that people were falling through the cracks, the health center in 2021 launched a grant-funded initiative to support victims of violence. In addition to lay counseling and therapy by licensed providers, available in several languages, the program, known as the Community Healing Unit, provides services such as helping clients access crime victim funds.

The program has sent 43 community health workers, case managers, and other employees to a lay counseling training program, said Ben Wang, the health center’s director of special initiatives. Trainees learn through formal instruction, observing teachers providing counseling, and practicing counseling with one another, along with feedback from instructors.

CMS-Approved Waivers Break New Ground for Medicaid Coverage of American Indian and Alaska Native Traditional Health Care Practices

November 1, 2024

On October 16, 2024, the Centers for Medicare & Medicaid Services (CMS) approved 1115 waivers in four states — Arizona, California, New Mexico, and Oregon — that, for the first time, allow state Medicaid agencies to cover American Indian and Alaska Native (AI/AN) traditional health care practices. These waiver approvals aim to support sovereign Tribal governments in providing health care services reflective of individual Tribes’ cultures and healing knowledge. In each of the four states and at the federal level, the waivers and the terms of the approvals were developed in partnership with Tribal leaders through formal Tribal consultation processes, public comment periods, and advisory groups.

Traditional health care practices, also known as traditional healing or traditional medicine, are a form of culturally centered care that has been shown to improve health and well-being, especially behavioral health and quality of life. This care can be offered as standalone services or alongside conventional Western (also known as allopathic) medical treatments to provide a multifaceted approach to health and well-being. Some traditional health care practices may be used across many cultures. For example, commonly offered traditional practices in Native American communities include talking circles, sweat lodges, and smudging. However, many other healing practices are unique to individual Native nations and locations. Because of the wide variability in traditional health care practices and the sometimes religious or spiritual meaning of these practices, the waiver approvals do not include a specific list of covered traditional healing services. Instead, the facilities providing these services can choose what to offer based on what will best meet the needs of the communities they serve.

All Medicaid benefits for AI/AN people received through IHS and Tribal facilities are paid for with a 100 percent federal match, in recognition of the federal trust responsibility to provide health care to Native people. This means states will receive a 100 percent federal match for traditional health care practices received by AI/AN people through IHS and Tribal facilities and UIOs that have care coordination agreements with IHS or Tribal facilities. States will receive their standard federal match for non‑AI/AN, IHS-eligible people who are receiving traditional health care practices.

The groundbreaking approval of these waivers has the potential to improve outcomes and decrease health disparities for Native people served by Medicaid, by improving access to culturally centered health care practices that have been used over many generations. Tribal and state leaders in Arizona, California, New Mexico, and Oregon are gearing up for implementation. Across the country, these approvals create a blueprint for other states to work in partnership with Tribal leaders to design and submit their own waivers.