How States Are Addressing The Youth Mental Health Crisis With ARPA

As states face a growing youth mental health crisis, they have relied on the American Rescue Plan Act to support initiatives that broaden access to care, according to a report from the Georgetown Health Policy Institute’s Center for Children & Families (CCF).

The American Rescue Plan Act, which the administration introduced in January 2021, put around $12 billion toward mental healthcare and substance abuse care in Medicaid home and community-based services (HCBS). Overall, states received 10 percentage points of federal funding matching for HCBS programs, which they can use through March 31, 2024.

States may receive varying amounts of support through the Act. For example, Wyoming received $19 million, which is the lowest amount of matching so far. Meanwhile, California has received the highest amount of funding, raking in $2 billion.

“To date, every state has submitted initial spending plans and narratives to CMS for approval in order to take up the opportunity,” the researchers explained. 

“We have reviewed the spending plans and narratives for the 50 states and DC posted by CMS on Medicaid.gov to see whether and how states are planning to use the funds to support children’s mental and behavioral health as part of their planned activities to enhance, expand, or strengthen HCBS.”

Overall, the researchers noted that states tended to apply the funding toward bolstering general mental and behavioral healthcare services, as opposed to focusing on youth mental and behavioral healthcare. However, the report highlighted four states that created extensive plans that targeted youth healthcare.

Alabama used American Rescue Plan Act funding to establish a community-based housing model tied to the state’s Department of Youth Services. Professionals would run the home, with programs that are tailored to patients’ specific, complex mental and behavioral healthcare needs.

Michigan leveraged the funds to bolster the state’s intensive crisis stabilization care. Michigan also put funding towards services that can support the families of children with severe mental and behavioral healthcare needs, such as case management, peer and parent support partners, and family therapy. 

Other relevant initiatives in Michigan sought to support the mental healthcare workforce. The state put funding toward enacting new certification criteria. The funds would also increase access to care by increasing eligibility for mental and behavioral healthcare support among youths in foster care or at risk of entering foster care.

Rhode Island intended to use the funds to create a single point of access for pediatric behavioral healthcare. The state would introduce a children’s behavioral health hotline, bolster care coordination, and take steps toward behavioral healthcare integration.

Lastly, the state of Washington strongly invested in children’s mental and behavioral healthcare needs. Some of its measures would support existing services, such as expanding the Children’s Intensive In-Home Behavioral Supports waiver.

However, other aspects of Washington’s plans might facilitate change in the state’s approach to pediatric behavioral and mental healthcare. Specifically, the state intended to alter its mental and behavioral health diagnosis process for patients who are newborns and up to five years of age. 

Additionally, Washington’s initiative to improve training on the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood: DC: 0-5 could result in catching mental and behavioral health conditions earlier.

Another nine states included youth-focused efforts in their HCBS plans for expanding behavioral and mental healthcare services.

These efforts encompassed including “children with behavioral health needs” as key populations in certain initiatives, providing behavioral healthcare aides through home healthcare, improving payment to pediatric mental and behavioral healthcare case managers, and offering incentive payments to primary care providers to support behavioral-physical care integration efforts.

The researchers noted, however, that in order to make a long-term impact policymakers should consider supporting the Build Back Better Act, which the researchers said would expand upon the American Rescue Plan Act’s efforts. Many payer leaders have expressed reservations about the Build Back Better Act.

The mental health crisis has been amplified by the coronavirus pandemic, but it did not begin with the public health emergency. Moreover, mental and behavioral health conditions can worsen chronic diseases.

Payers and employers have projected that mental healthcare needs will continue to trend upward, along with chronic disease management demands.