Over the coming months as more and more Americans are vaccinated, we'll begin to hear debate at the community, local, state and national level about what is needed for recovery. How will we help small businesses regain their footing? What supports can we give specific industries laid low by the shelter-in-place orders and other impacts of our new normal? What can we do to shore up our battered healthcare and public health infrastructure?
The answer to many of these questions will involve Medicaid and the Children's Health Insurance Program (CHIP), and therefore depend on federal and state leaders’ support for the directors of these programs in every state.
There are two reasons why Medicaid and CHIP have such a key role to play. The first has to do with the programs’ reach. These programs serve 77 million – about one in every five, and 6.6 million more since the national health emergency was declared – Americans, and many of them are essential workers, vulnerable children or older adults who’ve been disproportionately impacted by the pandemic if not physically, than mentally.
Consider what children alone are currently experiencing. Many are experiencing social isolation due to school closures, and are even enduring the secondary trauma of watching their parents and caregivers deal with the economic and health ramifications of COVID-19. Of the 37 million children and young people enrolled in either Medicaid or CHIP, mental health-related visits have increased in children ages 5 to 11 years old by 24 percent and for those 12 to 17 years-of-age by 31 percent.
Adults are having a hard time too. Addiction and substance misuse are on the rise, and more than one-third of all adults are currently experiencing symptoms of anxiety and depression. This is a more than 20 percent increase since 2019 that Medicaid leaders in individual states are already seeing the impact of. Treatments numbers are escalating, so much so that it’s likely Medicaid will soon serve far more than the current number – 11 million – of adults over 18 who have a mental health diagnosis.
Along with the program's reach into communities, Medicaid and CHIP have a considerable impact on our existing healthcare infrastructure. Investing roughly $600 billion into the healthcare infrastructure each year, Medicaid and CHIP are not only a stabilizing force, but a critical funder of the clinics, hospitals, nursing homes and other healthcare providers that all Americans rely on.
We are all familiar with the pandemic-related dichotomy of hospital emergency rooms overflowing with COVID patients while family doctors and clinics were forced to close their business as people stayed home and away from preventative and other care. But by Medicaid providing more than $600 billion dollars a year to healthcare infrastructure, many states were able to find ways to lessen barriers to care and keep these dollars flowing – a benefit to all of us, not just those who use Medicaid to access healthcare.
Given the means to do so, Medicaid directors across the country will just keep innovating in this way. They will take into account their local circumstances and challenges and forge the right path forward. They will break down barriers to access for clients and continue to find new ways to streamline payments to providers. They will strengthen and broaden their crisis response systems, and take more comprehensive approaches to mental health and addiction treatment that considers the whole person.
These directors need and deserve our support. And they need and deserve acknowledgment from both the federal and state leaders that they will be dealing with the pandemic's real impacts for years to come. Their programs represent a pathway to better health for tens of millions of Americans even if they aren’t Medicaid or CHIP beneficiaries, making this pathway an essential ingredient to our nation's recovery.
Matt Salo is the Executive Director of the National Association of Medicaid Directors.
Dr. Benjamin F. Miller (@miller7), PsyD, is the Chief Strategy Officer at Well Being Trust, the Advisory Board Chair for Inseparable, and author of ‘Mental,’ a weekly newsletter calling out how timely topics are connected to mental health, and calling for actions to improve it.