Improving Behavioral Health Care for Youth Through Collaborative Care Expansion

A white paper from the Meadows Mental Health Policy Institute and The Commonwealth Fund finds a key solution to the youth mental health crisis–expanding mental health care access.

The mental health system in the United States struggles to detect and treat mental illness early, particularly among adolescents and youth, exacerbating the current mental health crisis. One promising solution is integrated behavioral health care delivered within primary care settings. This approach allows for early screening and treatment, which is crucial for addressing youth mental health issues effectively.

The Collaborative Care Model (CoCM) stands out as the most evidence-based method for integrating behavioral health into primary care. Despite its proven effectiveness, especially for children and adolescents, adoption has been slow, particularly in pediatric practices.

A significant barrier to widespread adoption is the need for sustainable reimbursement. Medicaid, which insures nearly half of all U.S. children, plays a critical role in making CoCM accessible. While Medicare and many commercial plans already reimburse for CoCM, fewer than half of the states offer Medicaid reimbursement for this model. Even in states that do, the reimbursement rates are often low and inconsistent with Medicare, making implementation challenging.

Research conducted by Meadows Mental Health Policy Institute and The Commonwealth Fund highlights several barriers and facilitators to CoCM adoption in states like New York, North Carolina, Texas, and Washington. Two key recommendations to overcome these barriers include ensuring consistent and sustainable reimbursement and supporting health system practice transformation.

Furthermore, addressing the needs of transition-age youth (TAY, ages 19-25) is critical. These young adults face unique challenges as they age out of pediatric care. States can increase mental health access by supporting CoCM adoption in settings where TAY are likely to seek care, such as student health centers and FQHCs.

The youth mental health crisis requires a rapid and coordinated response. By advancing policies for national Medicaid coverage of CoCM, Congress, CMS, and state governments can significantly improve access to mental health care for the nearly 50% of youth covered by Medicaid. Integrating behavioral health into primary care is not just a viable solution—it is a necessary one for the well-being of our children and adolescents.

Read the full report from MMHPI and The Commonwealth Fund here.