Access to behavioral health care is Maryland’s ‘number one issue,’ as legislature discusses solutions to long ED wait times

Behavioral health is currently the top priority in Maryland’s health care sphere, according to Del. Joseline Pena-Melnyk (D – Anne Arundel), Chair of the Maryland House Public Health and Minority Health Disparities Subcommittee. 

The subcommittee met this week to hear updates from the Health Services Cost Review Commission (HSCRC), which devised a workgroup to address patients who are spending hours, days, and even weeks in emergency departments (ED) awaiting behavioral health care. 

 

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“ED wait times have been higher in Maryland [than nationally] for a long time,” said Megan Renfrew, HSCRC associate director of external affairs. “… That problem is worse for behavioral health patients, and the impact of that problem is even worse for patients with complex needs, and those who are under the age of 18.”

At a Sept. 2021 committee briefing on the Maryland Mental Health and Substance Use Disorder Registry and Referral System, the workgroup was tasked with finding short-term solutions to address the lack of psychiatric bed availability, crisis support, funding, and long ED wait times.

Renfrew outlined programs that the state could better utilize. These include the Behavioral Health Integration in the Maryland Primary Care Program (MDPCP), the Collaborative Care Model (CoCM) which focuses on Medicaid enrollees, and the Maternal Opioid Misuse (MOM) Model which focuses on care for pregnant and postpartum Medicaid enrollees with opioid use disorder (OUD).

Although the programs would divert patients seeking behavioral health care from EDs, Renfrew acknowledged that some patients may still end up waiting for a psychiatric bed. 

She highlighted a few programs that would assist those patients, including the Adolescent Hospital Overstay Grant Program that the Department of Health (MDH) and the Maryland Readmission Reduction Program. This program, set to begin this year, will provide people with severe mental illness and high ED utilization with case managers that will work to find resources to reduce their time in EDs.

Renfrew highlighted a few remaining barriers, including a lack of data, workforce shortages, and a lack of sustainable funding. 

Particularly with funding, Renfrew said many behavioral health programs receive most of their  funding from grants, which are less stable than provider reimbursements from payers. 

Renfrew noted MDH is currently awaiting approval for FY23 budgetary funding for the Maryland Mental Health and Substance Use Disorder Registry and Referral System to better scope the capacity for behavioral health facilities and resources. MDH applied for funding from the Major Information Technology Project Fund under the Department of Information Technology, and expects a response in “the next several weeks,” according to Renfrew.