Bill Overview
Title: A bill to improve outcomes for Medicaid beneficiaries with major depressive disorder or other mental health conditions.
Description: This bill requires the Centers for Medicare & Medicaid Services to issue guidance for state Medicaid programs on best practices to support individuals with major depressive disorder or other mental health conditions, including options that include pharmacogenetic testing.
Sponsors: Sen. Brown, Sherrod [D-OH]
Target Audience
Population: People with major depressive disorder or other mental health conditions
Estimated Size: 14000000
- Major depressive disorder affects about 5% of the global adult population according to the World Health Organization.
- Mental health conditions broadly affect a large portion of the population, not just those with depressive disorders.
- Pharmacogenetic testing is relevant for patients requiring medication for depression or other mental disorders.
- Medicaid beneficiaries are a subset of the total population who have low income and are covered by Medicaid.
- The bill targets improvements for Medicaid beneficiaries specifically with mental health conditions.
Reasoning
- The policy targets Medicaid beneficiaries with major depressive disorder or other mental health conditions, aiming to improve their treatment outcomes through best practices and pharmacogenetic testing.
- A budget of $500 million in year 1 may limit the number of people served initially, likely focusing on the most severe or costly cases to manage within Medicaid programs.
- Pharmacogenetic testing can optimize medication choices, potentially reducing costs and improving outcomes, but initial implementation may have steep learning curves and mixed results for different individuals.
- We expect a range of impacts from none to high due to variance in how pharmacogenetics and other best practices apply individually.
- To contextualize well-being scores, it's important to account for both direct impacts on mental health and indirect impacts via healthcare savings or other services becoming available.
Simulated Interviews
Retail Worker (Chicago, IL)
Age: 32 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 15/20
Statement of Opinion:
- I often feel that my current medication doesn't quite work for me.
- I'm hopeful that the new practices will lead to better options and outcomes.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 8 | 5 |
| Year 10 | 8 | 5 |
| Year 20 | 7 | 4 |
Construction Worker (Atlanta, GA)
Age: 45 | Gender: male
Wellbeing Before Policy: 4
Duration of Impact: 5.0 years
Commonness: 12/20
Statement of Opinion:
- I'm not sure if this will help me, but any improvement is welcome.
- It's hard to manage work and home life with the way I feel.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 5 | 4 |
| Year 3 | 6 | 4 |
| Year 5 | 6 | 4 |
| Year 10 | 5 | 3 |
| Year 20 | 5 | 3 |
Freelance Writer (San Francisco, CA)
Age: 28 | Gender: other
Wellbeing Before Policy: 3
Duration of Impact: 0.0 years
Commonness: 5/20
Statement of Opinion:
- This policy sounds promising, but it doesn't apply to me as I'm not on Medicaid.
- I hope it gets expanded to help more people in the future.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 3 | 3 |
| Year 2 | 3 | 3 |
| Year 3 | 3 | 3 |
| Year 5 | 3 | 3 |
| Year 10 | 3 | 3 |
| Year 20 | 3 | 3 |
Retired (Houston, TX)
Age: 60 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 10.0 years
Commonness: 8/20
Statement of Opinion:
- I've tried many medications, so pharmacogenetic testing might pinpoint something better for me.
- I struggle with knowing which meds work and often feel like a guinea pig.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 7 | 4 |
| Year 5 | 7 | 5 |
| Year 10 | 8 | 5 |
| Year 20 | 6 | 4 |
College Student (Portland, OR)
Age: 19 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 20.0 years
Commonness: 10/20
Statement of Opinion:
- I'm still adjusting to treatment, so anything helping me find the right meds faster is good.
- College is stressful, and anything that eases my anxiety is welcome.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 8 | 6 |
| Year 3 | 8 | 6 |
| Year 5 | 9 | 6 |
| Year 10 | 9 | 6 |
| Year 20 | 8 | 6 |
Administrative Assistant (Denver, CO)
Age: 51 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 8.0 years
Commonness: 14/20
Statement of Opinion:
- Any improvement in mental health care can have a really positive impact on my life.
- Medication adjustments have been tricky, so this could be a turning point.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 8 | 5 |
| Year 10 | 7 | 5 |
| Year 20 | 6 | 5 |
Truck Driver (Miami, FL)
Age: 39 | Gender: male
Wellbeing Before Policy: 4
Duration of Impact: 5.0 years
Commonness: 11/20
Statement of Opinion:
- More consistent treatment options would help stabilize my work and life balance.
- Getting the right medication faster could keep me on the road longer.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 4 | 4 |
| Year 2 | 5 | 4 |
| Year 3 | 5 | 4 |
| Year 5 | 5 | 4 |
| Year 10 | 5 | 3 |
| Year 20 | 4 | 3 |
Grad Student (New York, NY)
Age: 30 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 12/20
Statement of Opinion:
- If the policy makes better treatments available through Medicaid, it could improve my situation.
- My mental health affects my academic performance, so any help is appreciated.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 8 | 6 |
| Year 5 | 9 | 6 |
| Year 10 | 9 | 6 |
| Year 20 | 8 | 5 |
Homemaker (Nashville, TN)
Age: 47 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 8.0 years
Commonness: 9/20
Statement of Opinion:
- My partner's mental health struggle is part of my stress, so any new effective treatment would be helpful.
- We've been juggling proof of what could help for a while now.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 8 | 5 |
| Year 10 | 7 | 4 |
| Year 20 | 6 | 4 |
Restaurant Worker (Detroit, MI)
Age: 25 | Gender: male
Wellbeing Before Policy: 4
Duration of Impact: 15.0 years
Commonness: 13/20
Statement of Opinion:
- I'm hopeful that better practices would prevent future hospitalizations.
- I feel like I'm starting from scratch with new medications, so guidance will help.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 7 | 4 |
| Year 5 | 8 | 4 |
| Year 10 | 8 | 3 |
| Year 20 | 7 | 3 |
Cost Estimates
Year 1: $500000000 (Low: $400000000, High: $600000000)
Year 2: $510000000 (Low: $410000000, High: $610000000)
Year 3: $520200000 (Low: $415000000, High: $625000000)
Year 5: $540000000 (Low: $425000000, High: $650000000)
Year 10: $580000000 (Low: $450000000, High: $720000000)
Year 100: $700000000 (Low: $550000000, High: $850000000)
Key Considerations
- Guidance implementation will require coordination between federal and state Medicaid agencies.
- The effectiveness of the guidance will largely depend on state adoption rates and implementation fidelity.
- Pharmacogenetic testing is a developing field; its cost and effectiveness may change over time.
- The bill's impact on various states will vary based on current mental health support structures and Medicaid capabilities.