The Mental Health Workforce: A Primer

[Excerpt] Congress has held hearings and some Members have introduced legislation addressing the interrelated topics of the quality of mental health care, access to mental health care, and the cost of mental health care. The mental health workforce is a key component of each of these topics. The quality of mental health care depends partially on the skills of the people providing the care. Access to mental health care relies on, among other things, the number of appropriately skilled providers available to provide care. The cost of mental health care depends in part on the wages of the people providing care. Thus an understanding of the mental health workforce may be helpful in crafting policy and conducting oversight. This report aims to provide such an understanding as a foundation for further discussion of mental health policy

The National Health Service Corps

The National Health Service Corps (NHSC) provides scholarships and loan repayments to health care providers in exchange for a period of service in a health professional shortage area (HPSA). The program places clinicians at facilities—generally not-for-profit or government-operated— that might otherwise have difficulties recruiting and retaining providers. The NHSC is administered by the Health Resources and Services Administration (HRSA), within the Department of Health and Human Services (HHS). Congress created the NHSC in the Emergency Health Personnel Act of 1970 (P.L. 91-623), and its programs have been reauthorized and amended several times since then. The Patient Protection and Affordable Care Act of 2010 (ACA; P.L. 111-148) permanently reauthorized the NHSC. Prior to the ACA, the NHSC had been funded with discretionary appropriations. The ACA created a new mandatory funding source for the NHSC—the Community Health Center Fund (CHCF), which was intended to supplement the program’s annual appropriation. However, since FY2012, the CHCF has entirely replaced the NHSC’s discretionary appropriation. The CHCF is time-limited. Initially an appropriation from FY2011 through FY2015, the CHCF was subsequently extended in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA, P.L. 114-10) for two years (FY2016 and FY2017). As of the date of this report, no funding has been approved for the NHSC in FY2018. The program does not currently receive discretionary appropriations; consequently, funding for this program was not included in the continuing resolution for FY2018 (P.L. 115-56). From FY2011 through FY2016, the most recent year of final data available, the NHSC offered more than 33,500 loan repayment agreements and scholarship awards to individuals who have agreed to serve for a minimum of two years in a HPSA. In FY2016, the NHSC made 6,129 awards. The number of awards the NHSC makes is only one component of program size, because not all awardees are currently serving as NHSC providers; some are still completing their training (e.g., scholarship award recipients). As such, the NHSC also measures its field strength: the number of NHSC providers who are fulfilling a service obligation in a HPSA in a given year. In FY2016, total NHSC field strength was 10,493. NHSC providers are currently serving in a variety of settings throughout the entire United States and its territories. The majority of NHSC providers serve in outpatient settings, most commonly at federally qualified health centers

The Mental Health Workforce: A Primer

[Excerpt] Congress has held hearings and introduced legislation addressing the interrelated topics of the quality of mental health care, access to mental health care, and the cost of mental health care. The mental health workforce is a key component of each of these topics. The quality of mental health care depends partially on the skills of the people providing the care. Access to mental health care relies on, among other things, the number of appropriately skilled providers available to provide care. The cost of mental health care depends in part on the wages of the people providing care. Thus an understanding of the mental health workforce may be helpful in crafting policy and conducting oversight. This report aims to provide such an understanding as a foundation for further discussion of mental health policy

The Veterans Health Administration and Medical Education: In Brief

Training health care professionals including physicians1 is part of the VA’s statutory mission. It does so to provide an adequate supply of health professionals overall and for the VA’s health system. This mission began in 1946, when the VA began entering into affiliations with medical schools as one strategy to increase capacity. Some trainees in particular, those in the later years of training may provide direct care to patients, thereby increasing provider capacity and patient access. In the long term, training physicians at the VA creates a pipeline for recruiting physicians as VA employees. In 2014, the Veterans Access, Choice, and Accountability Act of 2014 (VACAA, P.L. 113 46, as amended) initiated an expansion of the VA’s medical training by requiring the VA to increase the number of graduate medical education positions at VA medical facilities by 1,500 positions over a five year period beginning July 1, 2015, through 2019.5 P.L. 114 315 extended this time period to 10 years (i.e., through FY2024)

The Changing Demographic Profile of the United States

[Excerpt] The United States, the third most populous country globally, accounts for about 4.5% of the world’s population. The U.S. population—currently estimated at 308.7 million persons—has more than doubled since its 1950 level of 152.3 million. More than just being double in size, the population has become qualitatively different from what it was in 1950. As noted by the Population Reference Bureau, “The U.S. is getting bigger, older, and more diverse.” The objective of this report is to highlight some of the demographic changes that have already occurred since 1950 and to illustrate how these and future trends will reshape the nation in the decades to come (through 2050). The United States Is Getting Bigger. U.S. population growth is due to the trends over time in the interplay of increased births, decreased deaths, and increased net immigration. The United States Is Getting Older. Aside from the total size, one of the most important demographic characteristics of a population for public policy is its age and sex structure. This report illustrates how the United States has been in the midst of a profound demographic change: the rapid aging of its population, as reflected by an increasing proportion of persons aged 65 and older, and an increasing median age in the population. The United States Is Becoming More Racially and Ethnically Diverse, reflecting the major influence that immigration has had on both the size and the age structure of the U.S. population. This section considers the changing profile of the five major racial groups in the United States. In addition, trends in the changing ethnic composition of the Hispanic or Latino Origin population are discussed. Although this report will not specifically discuss policy options to address the changing demographic profile, it is important to recognize that the inexorable demographic momentum will have important implications for the economic and social forces that will shape future societal well-being. There is ample reason to believe that the United States will be able to cope with the current and projected demographic changes if policymakers accelerate efforts to address and adapt to the changing population profile as it relates to a number of essential domains, such as work, retirement, and pensions; private wealth and income security; the federal budget and intergenerational equity; health, healthcare, and health spending; and the health and well-being of the aging population. These topics, among others, are discussed briefly in the final section of this report. This report will be updated as needed

The Community Health Center Fund: In Brief

This report provides information on the Community Health Center Fund (CHCF) that may be useful for discussions about the fund's future. Specifically, it includes information on: the types of grants awarded, total funds disbursed, and the amount of CHCF funds that facilities in each state and territory received

Federal Health Centers

This report provides an overview of the federal health center program including its statutory authority, program requirements, and appropriation levels. The report then describes health centers in general, where they are located, their patient population, and some outcomes associated with health center use. It also describes some federal programs available to assist health center operations including the FQHC designation for Medicare and Medicaid payments. The report concludes with a brief discussion of issues for Congress such as the potential effect of the ACA on health centers, the health center workforce, and financial considerations for health centers in the context of changing federal and state budgets

Public Health, Workforce, Quality, and Related Provisions in ACA: Summary and Timeline

Report containing reference material regarding the Affordable Care Act (ACA) individual provisions at the time of enactment. This report -- one in a series of CRS products summarizing ACA that were issued after the law's enactment -- describes the law's workforce, public health, quality, and related provisions

The Community Health Center Fund: In Brief

The report discusses the Health Center Program, which is administered by the Health Resource and Services Administration within the Department of Health and Human Services, awards grants to outpatient health care facilities that provide care to medically under-served populations

Federal Health Centers: An Overview

This report provides an overview of the federal Health Center Program, including its statutory authority, program requirements, and appropriation levels. It also describes federal programs available to assist health center operations, including the federally-qualified health center (FQHC) designation for Medicare and Medicaid payments, and concludes with two appendices that describe FQHC payments for Medicare and Medicaid beneficiaries