Medicaid and Private Insurance Spending on Behavioral Health Care in Virginia Increases from 2014 to 2020

In this new report, Altarum researchers publish findings from a study of trends in spending on behavioral health care in Virginia and find that overall spending on these conditions has increased from 2014 to 2020 among Medicaid enrollees and the privately insured. Using data from the Virginia All-Payer Claims Database (APCD) and National Survey on Drug Use and Health (NSDUH), they assess changes in mental health and substance use disorder condition prevalence; spending on overall behavioral health care, conditions, services, and treatment; spending by age and geography; and trends in spending by claim types and places of service.

Major findings from the report include:

• Medicaid health care spending on behavioral health care increased from $680 million in 2014 to over $2.0 billion in 2020, while private insurance spending increased from $990 million to over $1.8 billion.
• The prevalence of any mental illness in the prior year among all adults increased from 18.1% to 20.5% and rose even faster among the subset of just young adults (ages 18-25), increasing from 19.4% in 2014 to 31.7% in 2020.
• Spending on mental health care products and services was significantly greater than spending on substance use disorder treatment, likely due to a higher prevalence of these conditions and greater access to and willingness to seek treatment.
• By condition, the largest proportions of behavioral spending among Medicaid enrollees went towards mood disorders (30%), delirium dementias and related conditions (24%), and schizophrenia and other psychotic disorders (15%). Among private insurance spending, 33% went towards mood disorders, 24% to anxiety disorders, and 15% to adjustment disorders.
• Between 2014 and 2020, the percentage of Medicaid behavioral health spending delivered via telehealth or “in-home” settings increased from 17.1% to 47.8%, while spending in these settings for private insurance patients increased from 2.6% to 34.5% over the same period.
• Shares of spending in physician office settings fell for both payers, from 45.0% to 26.5% in Medicaid and 83.0% to 51.9% in private insurance, mostly due to COVID-19 impacts on the use of in-person care.
• Behavioral health spending varied significantly across Virginia health regions, as per-enrollee Medicaid spending in the Central region ($2,100) was double the spending per enrollee in the Northern region ($1,050).

Download the report to learn more and see additional findings. Detailed data sources and methodologies are included in a report appendix. The authors would like to thank the Virginia Hospital and Healthcare Association for their support of this work and the Virginia Health Information organization for their assistance and for providing data from the APCD.