TMS Coverage Exists in 16 State Medicaid Programs – Except in Colorado

Jan 26, 2024
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While TMS gains recognition as a highly effective, medication-free treatment for depression and anxiety, it is still out of reach for Colorado's Medicaid patients. It's a tale of disparities and gaps, with 16 states embracing the potential of TMS under..

TMS Coverage Exists in 16 State Medicaid Programs – Except in Colorado

TMS coverage in Colorado 

TMS is a treatment option for individuals with treatment-resistant depression and is covered by every commercial insurance provider. While Medicaid coverage for TMS is available in 16 states, unfortunately, Colorado is not among them. This lack of coverage in Colorado hinders access to this effective treatment for individuals who cannot afford it out-of-pocket. Given the potential of TMS to enhance mental well-being and provide a viable treatment option, TMS coverage under Medicaid can broaden access to effective mental healthcare for a larger population.

What is TMS? Why should Medicaid cover TMS?

TMS, or Transcranial Magnetic Stimulation, is a noninvasive treatment that utilizes short magnetic pulses to stimulate nerve cells in specific brain regions linked to major depression. This breakthrough technology offers more effective treatment than traditional methods, such as medication or therapy, with its precise targeting and minimal side effects. By directly influencing brain activity, TMS has shown promising results in alleviating depressive symptoms and improving overall mental well-being. According to a recent study conducted by Stanford, patients undergoing TMS therapy showed a remarkable 70%-80% success rate.

TMS coverage in Colorado offers numerous benefits for the general population. First, it enables more individuals to return to work, contributing to a stronger economy. According to studies done in Minnesota, for every point decrease in the Patient Health Questionnaire-9 (PHQ-9), a test used to assess depression severity, productivity increases by an impressive 1.65%. In other words, if we want a stronger economy in Colorado, helping people recover from depression may be a good place to start.

Between 2016-2018, 17,000 individuals went to the emergency room for a mental health diagnosis in Colorado. Not only did this add more than $76 million in costs, 2/3rds of the visits came from Medicaid-insured patients. TMS therapy could reduce hospitalizations and emergency visits, improving overall healthcare outcomes and reducing public healthcare costs. Research also shows that children of depressed parents or caregivers have a higher risk of exhibiting signs and symptoms of anxiety and/or depression. In fact, the same study revealed that 1 in 4 mental health emergencies diagnosed in the emergency room were children. The concurrent effects of a family member’s depression underscore the importance of addressing mental health disparities and improving access to effective treatments, as it has a direct impact on individual well-being, the broader community's productivity, and the family unit.

Stigma was cited by 47.3% of Coloradans as a reason not to get mental healthcare. For communities of color, there still exists a general distrust of medical institutions, given incidents like the Tuskegee study, and forced sterilizations in different minority groups, and many under coercion. TMS is a medication-free treatment that does not require any downtime for the patient. The medication-free nature of the treatment enhances accessibility to treatment for people of color, addressing healthcare disparities and promoting equity in the state.

Medicaid Coverage for TMS Across the United States

Sixteen states in the United States currently offer Medicaid coverage for Transcranial Magnetic Stimulation (TMS). These states include Arizona, Connecticut, Indiana, Iowa, Minnesota, Missouri, Montana, Nevada, New Jersey, Oregon, Pennsylvania, Rhode Island, South Dakota, Utah, Vermont, and Washington state. However, it is important to note that most states only cover TMS for treatment-resistant depression. In order to be eligible for coverage, patients are typically required to have tried and failed to see improvement with at least two medications.

Analyzing the Medicaid Program in Colorado

Colorado's Medicaid program has come under scrutiny for its inadequate coverage of mental health services. In terms of adult mental health and access to care, Colorado ranks 45 among all states, highlighting the urgent need for improvements. Current mental health Medicaid coverage in Colorado includes a range of services, but it does not currently cover transcranial magnetic stimulation (TMS) for the treatment of depression. TMS, although approved by the FDA in 2008, is still considered relatively new in the field of depression treatment. Surprisingly, while 16 other states have included TMS in their Medicaid coverage, Colorado has yet to do so. The reasons behind this exclusion remain unclear, but it is crucial to address this issue to ensure that individuals suffering from depression have access to the full range of evidence-based treatments available.

Implications of the Lack of TMS Coverage in Colorado Medicaid

The lack of Transcranial Magnetic Stimulation (TMS) coverage in Colorado Medicaid has significant implications for patients in need of this treatment. Unlike 16 other states that include TMS in their Medicaid programs, Colorado's exclusion limits access to a non-invasive and potentially effective therapy for individuals with conditions such as depression and anxiety. This discrepancy raises concerns about equitable access to mental health treatments and highlights the need for Colorado to reconsider its coverage policies in comparison to other states.

Advocating for Medicaid patients to get TMS Coverage in Colorado

We believe so strongly in the effectiveness of helping patients recover from depression and anxiety with TMS that we have committed $100,000 to covering TMS treatment for Medicaid patients in Colorado. This makes Axis Integrated Mental Health the ONLY clinic in all of Colorado where Medicaid is accepted for TMS. We hope to inspire other mental health clinics serving the community to follow suit.

Join us in advocating for TMS coverage in Colorado by writing to our governor Jared Polis. We believe that by engaging with policymakers and stakeholders, we can take steps towards promoting TMS coverage in the state. Your support is crucial in ensuring that individuals suffering from mental health conditions have access to this innovative and effective treatment option. Stand with us as we work towards improving mental health care in Colorado.

Colorado Medicaid should include TMS coverage

It is imperative for Colorado Medicaid to include TMS coverage. With 16 other states already recognizing the safety and effectiveness of TMS in treating depression, it is concerning that Colorado, ranking last in the nation for mental health, has yet to adopt this crucial treatment option. By expanding Medicaid coverage to include TMS, Colorado can improve access to innovative mental health care and provide much-needed support to individuals struggling with depression. Help raise awareness by sharing this blog post on social media. Together, we can advocate for comprehensive mental health coverage in Colorado.