How health insurance coverage affects children’s access to mental health care

How health insurance coverage affects children's access to mental health care

Emergency rooms see nearly half a million children each year for mental health conditions, according to the American Academy of Pediatrics, and that number is growing.

Children ages 6 to 17 have a growing need for mental health services, with 1 in 6 reporting at least one mental health disorder, according to a 2019 paper from researchers at the University of Michigan. And that was before the COVID-19 pandemic, which has hit children’s mental health hard. High school students are increasingly reporting persistent feelings of sadness or hopelessness. According to the Centers for Disease Control and Prevention’s Youth Risk Behavior Survey, 42% of high school students experienced these feelings in 2021, an increase of five percentage points from 2019 and 14 points higher than in 2011.

However, about half of young people who need professional mental health services do not get them, according to the same Michigan researchers. Among the barriers to accessing mental health care for children is health insurance coverage.

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Getting children the help they need covered by insurance can be difficult for parents, despite laws requiring equality of mental and physical health coverage. Historically, health insurers have provided little in the way of mental health benefits. In 1996, a federal law introduced the idea of ​​covering mental health at the same level as physical health services, but not for all health plans. That concept was expanded by the Mental Health Parity and Addiction Equity Act of 2008, which requires insurers to treat mental and physical health coverage equally.

As such, NPR reports that insurance companies tend to be lax about ensuring equal coverage for mental health care, often treating mental illness as an acute condition instead of a chronic condition that may require long-term care.

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The laws apply to most health plans, but there are several types of exceptions, the Kaiser Family Foundation reports. NPR reported an example where an Ohio family had to pay $40,000 out of pocket for their daughter’s residential treatment for chronic suicidality after their insurer stopped coverage. The family eventually waded through the red tape to continue treatment and get their expenses reimbursed.

Schools are trying to provide support because untreated mental health conditions can harm students’ learning and development. The Substance Abuse and Mental Health Services Administration found in 2019 that 15% of teens received mental health services at school. But that is not enough to meet the demand.

How Health Insurance Coverage Affects Children'S Access To Mental Health Care

How Health Insurance Coverage Affects Children'S Access To Mental Health Care

Map showing almost 40% of children in the US are covered by Medicaid. More than half of minors rely on Medicaid for insurance in New Mexico, Arkansas, and Louisiana.

Medicaid and the Children’s Health Insurance Program, or CHIP, provide youth up to age 21 in Medicaid and age 19 in CHIP with more comprehensive mental health services through the Early and Periodic Screening benefit, Diagnostic, and Treatment, according to KFF.

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Under that benefit, youth can receive screenings for mental health, behavioral health, and developmental issues—along with physical health screenings—and get any services needed to treat any mental and behavioral issues. diagnosis, even if the state’s Medicaid program does not cover the service. According to The Commonwealth Fund, the benefit allows young people on Medicaid to get better, more complete mental health services than young people covered by commercial insurance.

Many states use Medicaid programs to reach children through school-based services—21 states have laws that extend Medicaid to cover school-based health care, including services in mental health. For example, young people covered by Medicaid in Colorado can access mental health services without a formal diagnosis, allowing for earlier intervention, according to a report in the Week of Education.