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The Impact of the One Big Beautiful Bill on Behavioral Health and Telehealth Access [PODCAST]

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In this episode, Denise Gaulin, Principal for Windham Brannon’s Healthcare Advisory Practice, unpacks the impact of the One Big Beautiful Bill on behavioral health access in America.

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Highlights of this episode include:

  • What inspired the creation of the One Big Beautiful Bill
  • How the bill improves access to behavioral health services
  • What permanent telehealth coverage means for patients in rural or underserved communities
  • Stories emerging from the field
  • Feedback that patients are giving

Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast.  We’re pleased to welcome Denise Gaulin. Denise is a Principal for Windham Brannon’s healthcare advisory practice and is a recognized healthcare industry expert with more than 30 years of experience. Prior to joining Windham Brannon, she was a senior client management executive who led complex engagements for a top 20 national consulting firm, including procurement activities, scope development, strategy development, and client management. She also helped to lead merger and acquisition due diligence on behalf of private equity and venture capital firms. Denise has experience as a healthcare litigation expert working cases that involved provider governmental investigations and payer provider payment disputes. Denise was also one of the first healthcare industry women to earn an equitable partnership position in a Forbes Best Accounting Company. Denise earned her Bachelor of Science from Radford University and serves as an instructor for the Healthcare Financial Management Association, American Health Law Association, Healthcare Compliance Association, Healthcare Information and Management Systems Society, and the Association of Healthcare Internal Auditors.

This episode dives into the One Big Beautiful Bill, a sweeping piece of legislation that’s changing how patients access behavioral health services through telehealth. We’ll explore how this bill is especially impacting rural communities, supporting caregivers, and transforming the way the underserved communities receive mental healthcare. From digital access to community-based support, we’re asking, what does this mean for real people navigating real challenges? And how can we ensure these changes truly serve those who need them most? We will unpack the impact and explore what’s next for behavioral health access in America. Welcome and thank you for joining us, Denise.

Denise Gaulin: Thank you, Kelly. It’s great to be with you this afternoon.

Kelly: We are happy you’re here. So, let’s go ahead and jump in. So, what inspired the creation of the One Big Beautiful Bill? And what gaps in behavioral health and telehealth was it aiming to address?

Denise: I think the inspiration has very little to do with behavioral health services and a lot more to do with the intent to reduce unnecessary federal costs and remove some of those rules and guidelines that are perceived to be roadblocks to productivity, to business growth, to tax-related situations. But the one piece in which it does absolutely impact behavioral health is the access to behavioral health through telehealth. It doesn’t appear that the impact and the access was considered with the exception of the ability to use telehealth. Previously, all services for behavioral health were really meant to be face-to-face interactions. With the act, we now have access to that. So herein lies the problem. Globally, with the federal funding for the Medicaid program being cut, as we’ve all heard and seen, there is a significant impact on healthcare coverage, both for the hospitals and for the patients. Some studies have reported the hospitals could see annual revenue losses of up to $25 billion annually and an increase of the uninsured to grow by 14 million patients by 2034. Unfortunately, this really is most significant in those states and rural communities that rely on Medicaid funding to provide all services, but particularly mental health services. So, there is a significant impact on access to behavioral health with the reduction in the Medicaid program.

Kelly: Thank you for explaining that for us. That was very interesting. How does the bill improve access to behavioral health services for patients who previously faced barriers?

Denise: Well, I do think the bright light to this whole thing is the ability to provide behavioral health services via telehealth. In these rural communities, resources are limited; funding is limited. And obviously, as we see almost every day in the news, there’s a lot of people who need those kinds of resources.

Kelly: Most definitely, completely agree with that. So, what does permanent telehealth coverage mean for patients in rural or underserved communities?

Denise: I think it could be very, very impactful in rural or underserved communities if telehealth becomes more accepted and more understood. Also, unfortunately or fortunately, telehealth, we talk about technology all the time. Telehealth requires technology and access to technology, which in many of these areas, it’s either not really accessible or it’s very difficult to access technology. And I really do think there’s a continued misperception about the use of telehealth, particularly in our older patients, patient populations who are not comfortable with using telehealth services for any of their care. So, it is really incumbent upon providers and communities to use marketing and exposure to the options so that they have an understanding that these resources are available and you can get them. It’s not that you have to go to a physician’s office or a provider’s office.

Kelly: Right. I mean, the technology is there, but it could be cost-prohibitive, or like you said, not even available. Are patients seeing faster or more flexible access to care since the bill passed? And what stories are emerging from the field?

Denise: Well, with the advent of the telehealth access, there is a growing belief that quicker scheduling and increased provider access is going to be available. I think we’re almost right now too early to really know what’s going to actually come out of this. It’s almost like we’ve got to wait and see. Are people going to become more comfortable using telehealth for mental health services? Are they going to go back to– if they do not have insurance via the Medicaid program, are they going to begin to go back and ignore the mental health services that they do need? There’s a lot of complexity in this. People have to have their prescriptions refilled. They have to have their chronic conditions taken care of. And there is some concern, at least from my perspective, that this kind of is going to fall on the bottom of the list.

Kelly: Yeah, let’s hope not. What feedback are patients giving about their experiences with behavioral healthcare since the bill’s implementation?

Denise: Well, there have and still are growing significant delays in provider resources, especially in rural communities. Scheduling is a problem. If you’ve ever tried to sign up, just go to a family practice physician as a new patient, the appointments are months out. And in the rural settings, it’s only worse. So, what I’m hearing, as I said very, very early, is that their patients are experiencing delays in the new patient visit availability and in just the opportunity to get engaged with a therapist. I am hoping that the patient experience with the advent of the telehealth can be a positive one. However, because as I said earlier, patients don’t really understand a lot of this yet, again, it’s a wait-and-see.

Kelly: Right. Yeah, it can be confusing for a lot of people. So how does the bill support access to behavioral health services for children and adolescents, especially in school or community settings?

Denise: Unfortunately, the bill doesn’t really have much impact on that. I’d say the biggest impact it does have is on the lack of funding via the Medicaid program. However, in my experience in many settings, community settings, school settings, there are other funding resources that are available and may be available. So, all organizations should really investigate these other funding resources, such as grant funding and that sort of thing. Investigate those as a replacement for the previous Medicaid funding. And really, time is of the essence because the funding, even the grant funding is kind of being focused on as well by the federal government. So, we’ve got to take advantage of where it is at the state and local level.

Kelly: Yeah. No, that makes a lot of sense. So how is the bill helping communities build stronger behavioral health support systems? And what local partnerships are emerging to improve access to care? And then how can patients and communities advocate for continued improvements in behavioral health access under the bill? And what role does public policy play in sustaining these changes?

Denise: So, I really do think that, as I said, local partnerships between state and government will be even more critical than they’ve ever been in the coming years. The federal government has the intention that states should be more responsible for their Medicaid programs within their states and the funding. Unfortunately, because these rural states who don’t have a lot of revenue resources are probably the hardest hit, we’ve seen a lot of stuff about local community hospitals closing. But the biggest piece of this is to create those partnerships between local and state government and always, always focus on ongoing communications between the local healthcare organizations, providers, patients, and the communities to provide behavioral health access points. Clarity on how to get assistance is important. Investigation of available grant funding as stated earlier is key to improving service availability and access and acceptance. And then going back to marketing, letting the communities know that resources do exist, even if they do not have health insurance, even if they are a self-paid situation, which happens a lot in mental health services. But there are resources and there is help. So, communication is going to be extremely important for between cities, states, local government, local healthcare providers, patients, and communities.

Kelly: Completely agree with you there, Denise. Thank you so much for joining us for this dive into the One Big, Beautiful Bill and its impact on behavioral health and telehealth access. We’ve heard how this legislation is reshaping care for patients, caregivers, and communities, and why it matters now more than ever. Thank you so much, Denise.

Denise: Thank you.

Kelly: And if a listener wants to learn more, contact you to discuss this important topic further, how best can they do that?

Denise: Yes, I can be reached at dgaulin@windhambrannon.com.

Kelly: Thank you for providing that. And thank you all for joining us for this episode of The Hospital Finance Podcast. Until next time…

[music] This concludes today’s episode of The Hospital Finance Podcast. For show notes and additional resources to help you protect and enhance revenue at your hospital, visit besler.com/podcasts. The Hospital Finance Podcast is a production of BESLER | SMART ABOUT REVENUE, TENACIOUS ABOUT RESULTS.

 

If you have a topic that you’d like us to discuss on the Hospital Finance podcast or if you’d like to be a guest, drop us a line at update@besler.com.

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