Adult Medicaid beneficiaries have foregone millions of primary, preventive and mental health care visits during the pandemic, according to new data by the Centers for Medicare and Medicaid Services (CMS). The decline happened at a time when preliminary evidence shows mental health conditions worsened nationwide.

CMS compared data from March through October of 2020 and 2019. The data found that mental health services for Medicaid beneficiaries between the ages of 19 and 64 declined by 22% in 2020 compared to the same period in 2019. Although utilization rates for some treatments have rebounded to pre-pandemic levels, mental health services have been the slowest to show improvement.

CMS said the gap in service utilization during the COVID-19 public health emergency, particularly in mental health services, could have a substantial impact on long-term health outcomes.

President Joseph Biden’s American Rescue Plan provides $3 billion in block grant funding to address mental health and substance abuse prevention, treatment and recovery services.