Jane M. Zhu (
Stephanie Renfro, Oregon Health & Science University.
Health Aff (Millwood). 2023 Apr;42(4):556-565. doi: 10.1377/hlthaff.2022.00805.
Medicaid is characterized by low rates of provider participation, often attributed to reimbursement rates below those of commercial insurance or Medicare. Understanding the extent to which Medicaid reimbursement for mental health services varies across states may help illuminate one lever for increasing Medicaid participation among psychiatrists. We used publicly available Medicaid fee-for-service schedules from state Medicaid agency websites in 2022 to construct two indices for a common set of mental health services provided by psychiatrists: a Medicaid-to-Medicare index to benchmark each state's Medicaid reimbursement with that of Medicare for the same set of services, and a state-to-national Medicaid index comparing each state's Medicaid reimbursement with an enrollment-weighted national average. On average, Medicaid paid psychiatrists at 81.0 percent of Medicare rates, and a majority of states had a Medicaid-to-Medicare index that was less than 1.0 (median, 0.76). State-to-national Medicaid indices for psychiatrists' mental health services ranged from 0.46 (Pennsylvania) to 2.34 (Nebraska) but did not correlate with the supply of Medicaid-participating psychiatrists. As policy makers look to reimbursement rates as one strategy to address ongoing mental health workforce shortages, comparing Medicaid payment across states may help benchmark ongoing state and federal proposals.
医疗补助计划的特点是提供者参与率低，这通常归因于报销率低于商业保险或医疗保险。了解各州之间的心理健康服务医疗补助报销差异的程度，可能有助于阐明增加精神科医生参与医疗补助计划的一个手段。我们使用了 2022 年各州医疗补助机构网站上公开的医疗补助服务费用表，为精神科医生提供的一组常见心理健康服务构建了两个指数：一个是医疗补助与医疗保险指数，用于为同一组服务对标每个州的医疗补助报销与医疗保险报销；另一个是州与全国医疗补助指数，用于比较每个州的医疗补助报销与按入保人数加权的全国平均水平。平均而言，医疗补助计划向精神科医生支付的费用为医疗保险计划的 81.0%，大多数州的医疗补助与医疗保险指数都低于 1.0（中位数为 0.76）。精神科医生心理健康服务的州与全国医疗补助指数范围从 0.46（宾夕法尼亚州）到 2.34（内布拉斯加州），但与参与医疗补助计划的精神科医生的供应没有相关性。随着政策制定者将报销率作为解决持续存在的心理健康劳动力短缺问题的策略之一，比较各州的医疗补助支付情况可能有助于为正在进行的州和联邦提案提供基准。
