Lawmakers have introduced new legislation aimed at improving Medicaid pediatric behavioral health access by allowing children enrolled in Medicaid to receive physical and behavioral health appointments on the same day. The Improving CARE for Youth Act, introduced to the House of Representatives by Congressman Dr. Neal Dunn (R-FL) and Congresswoman Angie Craig (Minn.-D), seeks to remove a longstanding billing restriction that has limited coordinated care for pediatric patients.
This bill represents a significant step toward improving Medicaid pediatric behavioral health access, enabling primary care providers to refer children to behavioral health specialists and receive reimbursement for both visits on the same day, fostering more integrated and timely care for vulnerable youth.
Medicaid Billing Restrictions Impact Pediatric Behavioral Health Access
Currently, Medicaid providers can only bill once per day for services provided to a patient, which restricts Medicaid pediatric behavioral health access when a child requires both physical and behavioral health care on the same day. This limitation discourages providers from offering coordinated same-day visits, which can delay treatment or fragment care.
The Improving CARE for Youth Act would amend the Social Security Act to allow primary care doctors to bill and be reimbursed for both physical and behavioral health visits on the same day. This change would remove a key barrier to Medicaid pediatric behavioral health access, encouraging collaboration among healthcare providers and improving timely access to behavioral health services for children.
Pediatric Mental Health Crisis Demands Improved Medicaid Access
The urgency of improving Medicaid pediatric behavioral health access cannot be overstated. The mental health of America’s youth has worsened significantly in recent years, a trend intensified by the COVID-19 pandemic. In 2021, nearly half of high school students reported feeling sad or hopeless, with almost 30% experiencing poor mental health, according to CDC data.
Congressman Dunn highlighted the importance of the bill: “Protecting the future of the youth in our country is too important to be hindered by a Medicaid billing restriction. Fixing same-day billing for Medicaid beneficiaries may seem like a small change, but it will have a big impact. We must ensure all children have access to the quality care they need.” This bill aims to enhance Medicaid pediatric behavioral health access, particularly for low-income families who depend on Medicaid coverage.
Moving Toward Integrated Care Models for Children
The bill aligns with broader efforts to integrate physical and behavioral health care. While many recent initiatives focus on adults, improving Medicaid pediatric care access remains a critical priority. The Centers for Medicare and Medicaid Services (CMS) launched the Innovation in Behavioral Health Model in 2024 to promote integrated care for adults, setting a precedent for expanding these efforts to pediatric care.
Pediatricians are often the first healthcare providers to identify behavioral health concerns in children and teens. However, not all practices have the capacity to deliver integrated behavioral health services. Companies like Fort are partnering with primary care providers to expand virtual pediatric behavioral health services, enhancing Medicaid behavioral health access through telehealth and collaboration.
Benefits of Enhancing Medicaid Pediatric Care Access
Allowing same-day billing for physical and behavioral health visits is more than a billing fix; it promises to:
- Improve early intervention by providing quicker access to behavioral health care
- Reduce logistical barriers for families needing multiple appointments
- Normalize behavioral health as a part of overall healthcare, decreasing stigma
- Foster better collaboration between primary care and behavioral health providers
These benefits directly support expanded Medicaid behavioral health access, ultimately improving health outcomes for children.
What’s Next for the Improving CARE for Youth Act?
The bill will need to pass through congressional committees and gain wider support to become law. Given the increasing focus on children’s mental health and healthcare access, the Improving CARE for Youth Act could receive bipartisan backing.
As the legislation moves forward, it represents a promising effort to remove systemic obstacles to Medicaid behavioral health access and build a more integrated, child-centered healthcare system.
