The mental healthcare landscape in Nebraska is being upended by policies for reimbursing providers who see patients covered by both Medicare and Medicaid. Systems say they're losing money, resulting in access gaps for older low-income clients.

Providers say the key concern has to do with serving patients considered dual-eligible, meaning they're enrolled in Medicare and Medicaid. This year, the federal government expanded the scope of professionals who can see Medicare patients for therapy and be reimbursed.

But Jon Day, executive director of Blue Valley Behavioral Health, said because of how Nebraska policy aligns with dual-eligible situations, practitioners are now seeing rates cut in half.

"More providers are coming out and saying, 'Oh my gosh, we can't see these people cause we're losing money.' So, we either refer them out, or they're not taking on people as well," he explained.

Day estimates a $200,000 revenue loss for his system and added that it's not easy to refer clients elsewhere because of provider "deserts" in some areas. Those working with the Nebraska Assocation of Behavioral Health Organizations have been meeting with state Medicaid leaders, noting the state can cover the difference without taking on extra costs. But progress on a final solution has been slow.

Providers say they understand the federal government's desire to bring more mental health professionals to the table in seeing patients. But they add unintended consequences at the state level almost defeat the purpose.

Chase Francl, CEO and president of the Mid-Plains Center for Behavioral Healthcare Services, said this is a heartbreaking situation.

"There's such a low margin on any behavioral health services, and any small disruption really can have catastrophic effects," he said.

Even though fixes offered by these providers are described as solutions without extra costs, they acknowledge the challenging environment given the appetite among elected officials to reduce the state's budget. As for the federal change that brought this situation to light, Licensed Independent Mental Health Practitioners can now be reimbursed under Medicare, and not just those with Masters or doctoral degrees in Social Work.

A new report finds that Maryland has made progress in providing school mental health services to its students but work still remains. The report by the national mental health advocacy organization, Inseparable, measures states based on 13 policy targets.

Maryland has improved its ratio of social workers to students. There is one social worker for every 620 students - a decline from more than 2,300 students in previous years. But the state has not implemented, or only partially implemented, five policies, such as expanding Medicaid coverage to include school-based mental health services.

Caitlin Hochul, vice president of public policy with Inseparable, said providing mental health services in schools has major impacts on students and parents alike.

"You're reducing the financial strain on parents," she explained. "You're reducing the need for reliable transportation. You don't need to be taking a lot of time off of school to go travel to an appointment, so it really helps give kids the resources and tools they need to get back in the classroom and learn."

Maryland also lacks mental health screenings of students, a tool that advocates say is critical to identify potential mental health issues.

The Maryland state legislature recently passed laws geared toward bolstering the behavioral health workforce. One law made school mental health professionals eligible for the state's loan repayment plan, and another created a state workforce development program for mental health professionals.

Sen. Malcolm Augustine, D-Prince George's County, said a focus of the state legislature has been working to bring - and keep - mental health professionals in the state.

"It's challenging right now for us to attract and retain these folks," he said. "It's a global issue, so we are trying to do our very best to create opportunities for them to have their loans repaid, opportunities for them to grow professionally, in the hopes that we'll be able to retain and grow our own."

Maryland lawmakers also passed laws requiring education and health agencies to provide guidelines for student telehealth appointments on school days.

The Iowa Legislature is weighing a measure to expand the use of psychedelic mushrooms to treat Post-Traumatic Stress Disorder and other mental and emotional disorders.

House File 978 passed the House and awaits action in the Senate.

Rep. John Wills, R-Spirit Lake, sponsored the measure, and said it would create a board to oversee the use of psilocybin, including the one found in so-called "magic mushrooms."

"Right now, there is data and proof that shows 82% of the time, a person with PTSD will have symptoms reduced and/or completely cured with as little as one treatment of psilocybin in a controlled environment," Wills explained. "That's the key, it has to be done in a controlled environment."

Wills emphasized the setting is important because mental health professionals counsel patients through a past traumatic event during the experience, and help them find a positive way to process it.

Wills, a military veteran himself, noted mental health professionals can use psilocybin to help address the high suicide rate of U.S. military vets who suffer from PTSD, and added using it in a controlled setting could benefit other people, too.

"Police officers, firemen, emergency room doctors," Wills outlined. "Anybody that suffers trauma at some point and has PTSD or suffers PTSD symptoms, they are more likely to commit suicide."

Neighboring states, including Minnesota and Michigan, have decriminalized psilocybin possession in some cities, but it has not been fully legalized for therapeutic use. The National Institutes of Health has warned against unrealistic expectations, given that psilocybin use is still only in clinical trials.


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Colorado has made significant improvements in connecting young people with the mental health care they need, according to the mental health advocacy organization Inseparable's latest School Mental Health Report Card.

Many of those gains could be erased if the Trump administration signs off on cuts to Medicaid.

Sen. Dafna Michaelson Jenet, D-Commerce City, said Colorado relies on Medicaid dollars to reach students where they spend most of their time - in school.

"We use Medicaid to cover a lot of school-based health center care," Michaelson Jenet pointed out. "We could lose that completely, and then how do we fund our school based health centers?"

Since the last report card in 2022, Colorado has improved the ratio of mental health professionals to students by adding 43% more psychologists and 70% more social workers. Colorado also got good marks for creating school environments embracing mental health, for example by allowing excused mental health absences and not disciplining students through exclusion.

The state also instituted annual mental health screenings but the future of the program is in question after Colorado's Joint Budget Committee, facing a $2 billion budget deficit, recently cut its funding.

Caitlin Hochul, vice president of public policy for Inseparable, said when you catch a condition early on, students are more likely to be more engaged in school, have academic success and perform better in the workforce later on.

"We really emphasize providing annual screenings to students so you can catch some of those symptoms or flags early on," Hochul explained. "Then connecting them with some of the care that they need."

Under Colorado's Taxpayer Bill of Rights, voters would have to approve any new revenues to pay for screenings and other initiatives not making the cut. Michaelson Jenet emphasized she is working to keep effective programs to protect children in place.

"One of the things that I'm grateful that the budget protected this year is the I Matter program, offering free therapy for any school-age youth who wants it," Michaelson Jenet noted. "From the beginning of I Matter, we have seen our suicide rate go down."