Medicaid, Elevated Behavioral Health Utilization Had Payers Talking in Q3

The ongoing need for behavioral health services will be no surprise to anyone involved in the industry.

Patients continue to have high rates of need and often present with greater acuity. This demand for behavioral health services was reflected across payers’ Q3 earnings calls. The result? Sky-high utilization levels.

For example, David Cordani, the CEO of managed care insurer the Cigna Group (NYSE: CI), said that the organization has seen behavioral health therapy utilization nearly double over just the last five years.

For some payers, the demand for behavioral services for Medicaid beneficiaries has especially increased. This trend aligns with the behavioral health industry’s general drift toward government health plan populations, in which providers increasingly court these demographics – garnering significant investor dollars in the process. 

Payers are working to improve access to behavioral health care for states’ Medicaid programs, sometimes at the behest of the states themselves, to meet the wave of need.

Tides in payers’ behavioral utilization — and the populations in which these trends are notably prevalent — demonstrate that behavioral health is as critical as ever and predict where the puck is moving in terms of most at-need populations.

In this update, I discuss:

• Behavioral health services utilization in Q3
• Payers’ relationships with Medicaid and Medicare segments
• How the industry at large works with federal health plans

How payers are leveraging behavioral health

Increased need for behavioral health care has been driven by geopolitical, economic and social factors, according to Cordani. Behavioral conditions have also become more expensive, contributing about 1% to employer cost trends in 2024 alone, he said.

“There’s interest in what programs and services we have available to address [behavioral conditions] as well as the link between mental and physical health,” Cordani said. “[It] has been shown [that] mental health utilization deflects physical health needs down the line.”

Whatever the exact concoction of factors driving usage, payers are now faced with meeting those levels of need and quieting cost trends. Cigna, a multispecialty health plan and health care services provider, has added almost 270,000 providers to its network in the last half-decade to address demand.

The payer also looked beyond the number of providers to improve access, offering coaching programs and offering online scheduling. These moves align with an industry that suffers from a perennial workforce shortage. More need does not equate to more clinicians, and industry players are all looking for solutions. Coaching as a mental health offering can meet lower-acuity patients’ needs, theoretically freeing up licensed therapists and social workers to handle more serious mental health cases. 

“Millions” of customers have used these services, Cordani said.

Behavioral utilization also increased for the Medicaid-focused managed care organization Molina Healthcare (NYSE: MOH). Costs rose, especially in certain areas, according to CEO Joe Zubretsky. In Kentucky, utilization management was suspended during the pandemic, and this program change led to more pronounced behavioral costs.

“But the stigma over receiving behavioral services is removed,” he said on the company’s Q3 call. “Providers are open for business. … It is a national trend.”

Improving access to behavioral health services doesn’t just lower costs for employers. It also has proven critical for payers’ bottom lines.

Enabling access to behavioral health services has been a key cost driver of UnitedHealthcare’s commercial business in 2024, according to Daniel Kueter, CEO of UnitedHealthcare’s employer and individual segment. He anticipates that the trend will continue into 2025.

It seems unlikely that upward trends in behavioral health services utilization will die down any time soon, so Kueter’s prediction could have an extremely long “best-by” date.

Government health plans and payers in Q3

Increased demand for behavioral services is one factor leading payers to expand access. Payers may now be looking to increase access for government health plan beneficiaries specifically.

States’ Medicaid programs specifically requested better access to care from payers from UnitedHealthcare, according to the company’s Q3 earnings call.

“Many of our states have looked to us to expand access to behavioral care,” Brian Thompson, CEO of UnitedHealthcare, said. “I think many of us that partner with our states have done so. That does have some cost implications.”

To cope with those cost implications, Thompson said he was “really hopeful” that these states would be more responsive than traditional rating cycles suggest.

UnitedHealthcare was not the only entity facing higher demand for Medicaid services. For Elevance Health (NYSE:ELV), Medicaid utilization increased across several of the company’s segments.

“On Medicaid … we are seeing some ongoing pockets of elevated trend,” Mark Kaye, chief financial officer of Elevance, said on the company’s Q3 call. “They’re most notable in the behavioral health area. Overall, we do expect margins to continue to remain pressured through the rest of the year.”

Medicare Advantage plans are also dialing in on behavioral health. MA plans are looking for a more holistic member experience which includes behavioral health, according to Heather Cianfrocco, president of Optum, UnitedHealth Group (NYSE: UNH)’s services arm.

This increased demand from federal health plans is unlikely to die down any time soon, as rates of behavioral health conditions show no sign of lagging among Medicaid and Medicare beneficiaries. 

The Medicaid opportunity

Behavioral health providers and investors have increasingly focused on Medicare and Medicaid populations and witnessed promising tailwinds.

While Medicaid rates were a challenge for some payers in Q3, autism therapy providers have noted positive trends. 

“It’s becoming a lot easier of a conversation with these states — to talk through that our ability to receive these rate increases is not about creating more profits for our individual organizations,” Rob Haupt, vice president of autism services at LEARN Behavioral, said at Behavioral Health Business’ Autism & Addiction Treatment Forum.

Baltimore-based LEARN Behavioral provides applied behavioral analysis (ABA), diagnostic and early intervention services in 18 states

Acting as potential proof of the favorable Medicaid environment, pediatric diagnostic and therapeutic company Cognoa recently forged a deal with Wyoming’s Medicaid program to cover its Canvas Dx product. 

For the autism therapy industry, a more favorable Medicaid landscape could allow providers to increase pay to attract staff and improve the quality of care. For the substance use disorder (SUD) treatment space, focusing on Medicaid populations allows providers to treat patients most impacted by SUD.

It can also be a key growth strategy.

New York City-based Ophelia’s growth strategy revolves around making alliances with Medicaid payers. The virtual opioid use disorder (OUD) treatment provider’s CEO, Zack Gray, previously told BHB that the company would grow geographically through payers’ footprints rather than by state lines.

The provider recently expanded its New Jersey Medicaid contracts to reach 89% penetration in the state. Reaching high penetration levels allows the company to perform “sustainably.” New Jersey’s Medicaid program is less fragmented than many other states, according to Gray, which made reaching a critical mass of Medicaid contracts much easier. 

Ophelia’s Medicaid play has attracted a total of $68 million in investor dollars. Another Medicaid-focused digital SUD treatment provider, Portland, Oregon-based Boulder Health, has more recently raised significant sums. Its latest raise of $35 million, in May, brought the company’s total raise to $85 million.

With these sums of cash on the line and improving rates, it seems all but certain that providers will continue to target federal health plan populations. As payers too see increased utilization in these groups, federal health plans are set to become even more important in the behavioral health industry.