This lesson goes over how mental health care is covered by Medicaid, a low-income insurance program. We’ll talk about how mental health care is provisioned and how the passage of the Affordable Care Act impacted this.
Medicaid and Mental Health
When you get sick or injured, if you have insurance, you go to the doctor and generally most of your expenses are covered. You might have to pay a little bit, known as a co-pay, but what about if you aren’t injured? What about if you’re seeking care for mental health issues?
The National Health Policy Forum estimates that about 6% of the adult population in the United States suffers from some type of mental illness. Mental health is a broad area and includes a number of different conditions.
This might be things such as depression or anxiety that require treatments like drugs or therapy. For some, though, access to these treatments might be difficult. That’s where Medicaid comes in.First thing first: what is Medicaid? Medicaid is an insurance program designed for low-income families and individuals. Those who make below a certain income are eligible for this program. It is a federal and state level program that helps provide care for those who cannot afford it.
Now, let’s talk about the kind of mental health coverage that Medicaid provides.
Mental Health Services
In 2010, laws about healthcare in the United States changed as a result of the passage of the Affordable Care Act (ACA), a law that expanded insurance coverage and made it more affordable.For this lesson, it’s important to note that The Affordable Care Act has changed the way that mental health care is covered by insurance. Two important changes happened with the ACA: it required that private insurance cover mental health care, and it expanded Medicaid’s coverage of mental health issues.Medicaid now covers what we call preventative care. This could be something like a depression screening in an adult.
The idea here is to get an idea of how to help someone before he or she becomes very ill.
Mental Health Care Requirements
The ACA requires that both private insurance and Medicaid provide access to rehabilitative services. This includes things like therapy programs to change behavioral issues, or access to substance abuse treatment and counseling.Here is another important change following the ACA that impacted mental health services: insurance providers cannot penalize people for pre-existing mental health conditions. That means if you get a new job and have private insurance and you have depression that requires treatment, your insurance plan cannot refuse to cover you or charge you more.
Insurance plans are also not allowed to put lifetime or yearly spending limits on what is called essential health benefits, which include mental health. That means if you need medication and therapy sessions to treat schizophrenia, there cannot be a spending limit placed on this by insurance.The ACA impacts something that people call mental health parity. What does this mean? Basically, mental health care coverage needs to be as robust as, or on par with, other types of care. So, the mental health care covered in your plan must be as broad and comprehensive as other kinds of care.
Basically, if you break your leg or if you are suffering from severe anxiety attacks, your insurance needs to treat these equally. This applies to Medicaid and private insurance.You can’t be charged a separate deductible (the amount of money you have to pay before your insurance steps in and pays the rest) for mental health care.However, there remain some issues. For one thing, Medicaid coverage can vary by state. So, you might live in a state that allocates more funding to the program and your coverage might be better.
Additionally, mental health issues remain poorly understood and there is still a stigma associated with seeking care.
Medicaid is a program designed to help low-income individuals gain access to insurance when they otherwise might not be able to afford it. It was created to help low-income families whose jobs did not provide insurance gain access to coverage.
When the Affordable Health Care Act (ACA) was passed, there were some important changes made to how Medicaid provides care for people with mental health issues. First, the ACA requires that private insurance providers must cover mental health care, like preventative measures, rehabilitative services, or ongoing therapy.While Medicaid already provided some mental health care coverage before, the ACA expanded this coverage. The ACA also means that insurance cannot impost yearly or lifetime limits on how much can be spent on mental healthcare.
However, this is not perfect: Medicaid varies by state and some are simply better than others.An important take away is that Medicaid, and changes made to it by the ACA, is striving to make mental health as important as other health issues, and create coverage and plans that reflect this.