Amid the COVID-19 emergency, much attention has been focused on skilled nursing facilities and hospitals. Skilled nursing facilities have accounted for over 40% of the nation’s COVID-19 deaths, while hospitals have faced critical shortages of beds and personal protective equipment. As a result, the U.S. Department of Health and Human Services (HHS) has allocated billions of dollars in coronavirus relief specifically to these entities.
However, behavioral health providers have largely been overlooked, despite facing their own significant challenges. Chuck Ingoglia, president and CEO of the National Council for Behavioral Health, recently emphasized in an interview with Behavioral Health Business that it is time for HHS to prioritize these organizations.
Financial Struggles for Behavioral Health Providers
The National Council represents over 3,300 provider members, most of whom are safety net organizations serving under- and uninsured populations. During the pandemic, these providers have experienced reduced revenues and increased operational costs, forcing many to cut services.
According to a June survey conducted by the National Council, behavioral health organizations have seen an average 20% reduction in revenue. Some providers have experienced even higher losses. As a result, programs have been forced to close temporarily, and staff have been furloughed. This has created a self-perpetuating cycle of reduced revenue and reduced capacity, even as the need for mental health services has surged.
Rising Mental Health Needs During the Pandemic
The demand for behavioral health services has grown dramatically during COVID-19. CDC data from the second quarter of 2020 showed that anxiety symptoms were three times higher than the previous year, while depression symptoms were approximately four times higher. Drug overdoses also increased in several regions.
These trends underscore the importance of maintaining robust behavioral health services. Reducing capacity at a time of increased need could have serious consequences for public mental health, particularly for vulnerable populations served by safety net providers.
Challenges With Provider Relief Funding
While CARES Act Provider Relief Fund payments have offered some financial assistance, the process has been confusing for many behavioral health providers. Ingoglia highlighted the challenges faced by Medicaid and Medicare providers in navigating relief funding. Many behavioral health organizations serve populations with dual eligibility for Medicare and Medicaid, yet HHS initially approached relief funding in a binary fashion, requiring providers to identify as either Medicaid or Medicare recipients.
Automatic Medicare payments were distributed based on 2018 fee-for-service billing, but providers who did not attest to these payments in HHS portals were initially ineligible for additional Medicaid funding. This caused widespread confusion and left some organizations without the support they needed. HHS has since reopened the portal to allow providers who have received less than 2% of their net patient revenue in relief funding to apply for additional support, with a deadline of August 28.
Why Current Relief May Not Be Enough
Even with these adjustments, the average 2% relief payment is insufficient to address the significant revenue losses experienced by behavioral health providers. For example, one member organization with a $95 million annual budget received only $68,000 in an automatic Medicare payment. Such amounts are far below what is necessary to sustain operations and prevent service reductions.
Behavioral health organizations are also facing increased costs. Telehealth has allowed many providers to continue care remotely, but not every patient can participate effectively due to technology limitations or the nature of their treatment. Intensive outpatient programs and residential services have also been impacted by social distancing requirements, reducing capacity and revenue.
In addition to operational losses, organizations have incurred new expenses. Many behavioral health providers historically did not purchase personal protective equipment, but now must supply it for staff and clients. Other costs include overtime for staff covering shifts, home delivery of food and supplies for clients, and technology investments for telehealth services. These combined factors have placed unprecedented financial strain on behavioral health providers.
Limited Access to Other Relief Programs
Many behavioral health organizations have also sought relief through programs such as the Paycheck Protection Program (PPP). However, eligibility requirements and confusion during the initial rounds of PPP funding limited access for organizations with more than 500 staff, leaving some providers without these supplemental funds. Relief has been uneven across the industry, further highlighting the need for targeted federal support.
The Need for a Dedicated Behavioral Health Funding Stream
Ingoglia stressed that the federal government should establish a dedicated funding stream for behavioral health organizations, comparable to those provided for critical access hospitals, nursing homes, and federally qualified health centers. Such a funding stream would recognize the essential role behavioral health providers play in public health and ensure they have the financial resources to maintain capacity.
Currently, many organizations are experiencing tremendous stress while facing increased demand for services. According to the National Council, 71% of providers have had to cancel, reschedule, or turn away patients over the past three months. Without additional support, these reductions in capacity could have long-term consequences for the public mental health system.
Potential Future Challenges
Looking ahead, Ingoglia warned that budget cuts at the state level could further compromise behavioral health services if Congress does not appropriate additional support. As states and municipalities face financial shortfalls, reductions in funding for public mental health programs may exacerbate the current crisis.
The combination of increased demand, reduced revenue, and rising costs underscores the urgency of creating a dedicated behavioral health funding stream. Without targeted financial assistance, providers may continue to reduce services at a time when communities need them most.
Conclusion
Behavioral health providers have been on the front lines of the COVID-19 pandemic, providing essential care to vulnerable populations while facing unprecedented financial and operational challenges. While current relief programs offer some assistance, they have proven insufficient to sustain many organizations.
A dedicated funding stream for behavioral health providers is critical to ensuring that these organizations can maintain services, retain staff, and meet the growing mental health needs of their communities. As the federal government considers future relief measures, prioritizing behavioral health funding will be essential to safeguarding public mental health and preventing further service disruptions.
With the HHS Provider Relief Fund application deadline approaching on August 28, behavioral health providers must act quickly to secure the funding they are eligible for. Beyond immediate relief, sustained and dedicated federal support is necessary to preserve the capacity and resilience of the nation’s behavioral health system.
