Pennsylvania Proposes Increased Rates for Medicaid Behavioral Health Services
The Pennsylvania Department of Human Services (DHS) has announced plans to raise rates in its Behavioral HealthChoices program, which offers Medicaid recipients access to mental health, substance use disorder treatment, and other behavioral health services. These new rates, once approved by the federal Centers for Medicare and Medicaid Services (CMS), will be retroactive to July 1, 2024, for current 2024 contracts with DHS.
“Access to mental and behavioral health care is essential to our overall health and wellbeing. If we cannot get the care we need, our ability to participate in and engage fully in our responsibilities like work, school, and family will not be possible,” said DHS Secretary Val Arkoosh. “Maintaining access to care requires rates that reflect the cost of providing care, and this mid-year adjustment for Behavioral HealthChoices managed care organizations (BH-MCOs) is necessary to maintain a Medicaid program that meets our current needs and challenges, and helps Pennsylvanians continue to get the care they deserve.”
The rate increase follows a mid-year evaluation of the Behavioral Health managed care plans’ enrollment and usage patterns for different services and supports. Once approved, the increased rates will help ensure Medicaid recipients continue to have access to behavioral health services and enable managed care plans to more adequately compensate behavioral health providers, aiding in the recruitment and retention of essential workers in this field.
Governor Josh Shapiro has prioritized expanding funding for behavioral health services across the state since taking office. In his first year, he secured $20 million for county behavioral health programs, which hadn’t received new funding since 2008 and even experienced cuts in 2012. County behavioral health offices, often the first point of contact for individuals in need, were overdue for this increased funding to better serve their communities.
The bipartisan budget for 2024-25 built on last year's investments, allocating an additional $20 million for county mental health programs, resulting in a total of $40 million more in annual funding compared to pre-Shapiro levels.
The Shapiro Administration has also dedicated $5 million to crisis stabilization walk-in centers, which provide urgent behavioral health care, diverting individuals in crisis from emergency rooms or unnecessary encounters with law enforcement. This funding will target regions lacking these centers or needing resources to expand current facilities.
Additionally, Pennsylvania's Home and Community-Based Spending Plan, funded through the American Rescue Plan Act, has directed over $100 million towards strengthening the behavioral health workforce. Most of this funding went to recruitment and retention efforts, with $4 million allocated for expanding telehealth services and over $2 million for enhancing training, professional development, and peer support certifications.
Last year, Governor Shapiro established a Behavioral Health Council through executive order to encourage collaboration among stakeholders and improve the accessibility and quality of behavioral health services in the state.
If you or someone you know is facing a behavioral health crisis, call or text 988 to reach the Suicide and Crisis Prevention Lifeline.
PHLP will provide further updates on this proposed rate increased once it is reviewed by CMS.
