Advancing Health Podcast Summary

Episode: When Medicaid Disappears: How Cuts Could Devastate Behavioral Health Care in Rural America
Date: July 2, 2025
Host: Rebecca Chickey, Senior Director of Behavioral Health, American Hospital Association
Guest: Dr. John Olvan, Chair of Psychology, Sanford Health

Episode Overview

This episode delves into the critical role Medicaid plays in supporting behavioral health services in rural America, focusing on the challenges that rural health systems like Sanford Health face, and the devastating impact proposed Medicaid cuts could have on patient care. Dr. John Olvan offers both data and personal stories to illustrate how access to care—especially for behavioral health—is inextricably tied to Medicaid funding, particularly in frontier areas where resources are scarce and stigma remains a barrier.

Key Discussion Points and Insights

1. The Challenge of Delivering Behavioral Health in Rural America (00:25–03:50)

• Sanford Health’s Reach: Sanford operates across multiple Midwest and frontier states, covering about 2 million patients in highly rural areas, many classified as “behavioral health shortage areas.”
• Barriers to Care:
  • Provider shortages: Difficulty recruiting behavioral health professionals to remote regions.
  • Extreme travel distances: Patients may travel hours for appointments.
  • Loss of Anonymity and Stigma: In small communities, privacy concerns deter people from seeking behavioral health services.
    • “Everybody knows everybody's business, so it makes it really hard to reach out and seek care.” – Dr. Olvan (03:20)

2. Virtual Care and Infrastructure Solutions (04:21–07:37)

• Broadband and Technology: Sanford Health has heavily invested in virtual care to reach remote patients. Currently, about 1 in 5 behavioral health visits are virtual.
• Hybrid Models: Combination of virtual and in-person care, with creative solutions such as minimally staffed clinics offering telehealth in tiny towns like Lidgerwood, ND.
  • “If they have difficulties with their technology…we offer [virtual care] up to people at the clinic.” – Dr. Olvan (06:30)
• Comprehensive Care Approach: Integration of behavioral health with primary care, pharmacy, women’s health, etc.

3. Medicaid as a Lifeline in Rural Communities (07:37–12:02)

• Funding Mechanism: Medicaid is the largest payer for behavioral health services in rural areas.
• Impact Stories:
  • Dr. Olvan shares a case of a young, uninsured patient experiencing their first psychotic episode, who, through Medicaid, accessed medications, therapy, and primary care.
    • “If we can help this person out at that point on an early basis, we are really…bending the trajectory for their health throughout the course of that person's life.” – Dr. Olvan (09:45)
• Significance of Early Intervention: Early Medicaid-supported intervention leads to better long-term outcomes for patients.

4. The Real-world Impact of Medicaid Cuts (12:02–14:45)

• Dependence on Medicaid:
  • 50% of rural children and 18% of adults are covered by Medicaid. (11:33)
  • Foster children heavily rely on Medicaid for behavioral health coverage.
• Consequences of Cuts:
  • Loss of coverage would create dangerous gaps in care, especially for vulnerable populations.
  • States with Medicaid expansion have lower suicide rates and fewer psychiatric hospitalizations.
    • “In one study they looked at suicide rates … literally thousands of lives, they could see a reduction in completed suicides, which would suggest that there were thousands of lives saved.” – Dr. Olvan (13:09)
    • Telepsychiatry with Medicaid recipients showed a “38% reduction in inpatient hospitalizations, 18% reduction in emergency department visits.” (13:44)

5. Call to Action and Advocacy (14:45–17:49)

• Importance of Advocacy: Clinicians and citizens must get involved with policymakers to preserve and expand Medicaid.
  • “We all are responsible—whether in a healthcare setting or our elected officials—to improve the lives of the patients and the citizens of our states…and in a bipartisan way when we can get some things done that are truly meaningful.” – Dr. Olvan (16:43)
• Emphasis on Children and Preventative Care:
  • Children with Medicaid are four times more likely to have regular pediatric visits—paving the way for effective early intervention.
  • Adults on Medicaid are also more likely to get preventive care and maintain regular healthcare sources.

Notable Quotes & Memorable Moments

• On Stigma and Seeking Care:

  • “Everybody knows everybody's business, so it makes it really hard to reach out and seek care.” – Dr. Olvan (03:20)

• On Early Intervention:

  • “We are really, in some ways, bending the trajectory for their health throughout the course of that person's life.” – Dr. Olvan (09:45)

• On Medicaid’s Reach:

  • “50% of the kids in rural communities are covered by Medicaid and 18% of adults. Medicaid is also the largest payer for behavioral health.” – Rebecca Chickey (11:33)

• On Data Supporting Medicaid Expansion:

  • “In one study…folks who had access to Medicaid expansion, suicide rates go down…thousands of lives saved.” – Dr. Olvan (13:09)
  • “There was a study...participating in this telepsychiatry practice…a 38% reduction in inpatient hospitalizations, 18% reduction in emergency department visits.” – Dr. Olvan (13:44)

Timestamps of Key Segments

• 02:00–03:50: Rural barriers; provider shortages, stigma
• 04:21–07:37: Virtual care platforms and hybrid clinic solutions
• 08:08–10:27: Patient story on early intervention and Medicaid’s role
• 11:33: Statistics on rural Medicaid coverage
• 12:02–14:45: Medicaid cuts’ impact on special populations; research studies
• 15:19–17:49: Call to action, advocacy, and the importance of bipartisan solutions

Conclusion

This episode highlights that Medicaid is critical for behavioral health services in rural America—not just for individuals, but for the sustainability of entire rural health systems. Medicaid supports early intervention, reduces crises, and enables innovative care delivery in hard-to-reach areas. Proposed cuts threaten to unravel progress, with potentially devastating impacts on children, foster youth, and all rural residents needing behavioral healthcare. The call: Listeners, practitioners, and policymakers alike must advocate fiercely to preserve and expand Medicaid for the health of rural communities.