BY John Hawkins, President/CEO, Texas Hospital Association
It is time to treat behavioral health with the same urgency and importance as physical health – and ensure coverage reflects that reality.
Texas is in the midst of a mental health crisis. We can no longer idly stand by as the current system fails to meet patient needs across the Lone Star State. Texans deserve the highest quality of care, not to struggle accessing basic services when they need them most.
Data shows Texans experience mental health conditions at rates well above the national average, yet access to care falls far short of meeting that need. With over 5 million uninsured Texans, a growing shortage of behavioral health professionals and significant gaps in payer coverage for both children and adults, a bad situation becomes worse.
A strong continuum of care – including consistent access to services beyond initial treatment – is essential for long-term well-being. Yet too many behavioral health patients face gaps or have limited options such as clinical visits or inpatient hospital stay, without much in between. These shortcomings leave patients without the sustained support they need to recover and thrive and allow existing manageable conditions to advance into more critical ones.
For behavioral health patients to make progress in their treatment, the whole continuum of care is necessary to ensure access to right-sized care at the right time. That means having services that range in levels of care to meet each patient’s needs. In physical medicine, step-down services like rehabilitation and physical therapy are standard after hospitalization – yet behavioral health patients are rarely afforded the same structured transition.
Partial hospitalization programs (PHP) and intensive outpatient therapy (IOT) offer continued care without inpatient stays, with programs ranging from eight-hour sessions to a few hours a day, a few days a week. Patients can either “step up” from regular therapy into these services or step down after hospitalization. Further, these services cost a fraction of an inpatient stay. However, these essential options aren’t fully covered by Medicaid, preventing patients from receiving appropriate care.
In addition to providing flexibility in treatment to meet patients’ specific needs, this also helps with the gradual transition back to everyday life by reinforcing skills learned in treatment and is especially practical for those who work or attend school. Behavioral health care is not a one-size-fits-all scenario; rather, it requires a tailored, patient-centered approach that evolves over time. Full Medicaid coverage of these services is a step towards a full continuum of behavioral health services, just as in physical care.
Step-down services play a critical role in both patient outcomes and healthcare efficiency. By providing an appropriate level of care between intensive and general settings, they reduce unnecessary readmissions, lower administrative burden, and enable more flexible, cost-effective coverage. This translates to significant operational savings; for patients, it means safer transitions and better continuity of care.
There are those who argue that adding Medicaid benefits is too costly. However, in this case, the reverse is true. It is more costly to deprive behavioral health patients in Texas from lower-cost treatments that are easier on the patient, more tailored, and often more effective than their current options. The longer these patients go without a full suite of care options, the more financial burden must be borne by hospitals – a pressure that compounds over time and threatens our state’s already shaky access to care. Despite the fact that a number of managed-care plans and Medicare include step-down services in their benefits, and a number of other states have incorporated step-down services into their Medicaid benefits, the Texas Legislature has failed to do so. Notwithstanding multiple opportunities to strengthen the behavioral health Medicaid continuum of care, this benefit still goes uncovered, directly harming Texans who need it.
It is time to treat behavioral health with the same urgency as physical health – and ensure that Medicaid coverage reflects that commitment.