Insurance Coverage

Mental Health America’s 2015 State of Mental Health in America Report states that 42 million people suffer from some form of mental illness. Although the Affordable Care Act of 2010 expanded access to health insurance, Mental Health America reports that more than eight million people with mental illness are uninsured. Only 41 percent of individuals with mental illness in the United States report having received treatment.

SAMHSA’s latest Behavioral Health Barometer Report states similar findings: approximately 10 million people experienced serious mental illness (SMI) within the year prior to being surveyed. As illustrated in the graph below, the percentages of SMI were higher among those without health insurance, those living in houses with income that was less than 100 percent of the Federal Poverty Level, and those living in non-metropolitan areas.

Mental health care access_SAMHSA

Private Insurance Coverage for Mental Healthcare

Federal law prevents private health insurance companies from discriminating against patients because they have a mental illness–including substance abuse disorders (SUDs). According to the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), insurance companies must achieve “coverage parity,” which means mental health and physical health benefits and services must be covered equally. These include inpatient and outpatient services, both in-network and out-of-network, emergency care, prescription drugs, co-pays and deductibles.

Unfortunately, we have a long way to go to truly achieve coverage parity for mental health. As the National Alliance for Mental Illness (NAMI) reported in 2015, people affected by mental illness and SUDs face several barriers to accessing quality care. These include:

  • Challenges finding “in network” mental healthcare providers
  • Frequent denials of authorization by insurance companies for mental health and SUD treatment
  • Lack of access to psychiatric medications in health plans
  • High co-pays, deductibles and co-insurance rates, and high out-of-pocket costs for prescription drugs
  • Poor access to information for patients to make informed decisions about health insurance options under the Affordable Care Act

Although it is not uncommon for insurance companies to deny mental healthcare treatment, there are several steps you can take if you feel you have been wrongly denied care. For more information, see NAMI’s resource: What to Do If You’re Denied Care By Your Insurance. For more information about coverage parity, see NAMI’s Mental health parity infographic.

Medicaid Coverage for Mental Healthcare

Medicaid, a US government program, is the largest payer for mental health services in the country. Medicaid provides free or low-cost health coverage to millions of Americans, but eligibility, coverage and costs varies state by state.

Your eligibility for Medicaid may depend on whether your state has expanded Medicaid coverage under the new healthcare law (the Affordable Care Act). States that have expanded Medicaid to cover all low-income adults determine eligibility based only on income and household size. States that have not expanded Medicaid coverage may determine eligibility based on income, household size, disability, family status and other factors. A map of states that have expanded Medicaid appears below. Find out about the Medicaid coverage in your state here

Source: Kaiser Family Foundation
Source: Kaiser Family Foundation

While states determine what services their Medicaid plans provide, federal rules state that their plans must include:

  • Inpatient hospital services
  • Outpatient hospital services
  • Prenatal care
  • Vaccines for children
  • Physician services
  • Nursing facility services for persons aged 21 or older
  • Family planning services and supplies
  • Rural health clinic services
  • Home health care for persons eligible for skilled-nursing services
  • Laboratory and x-ray services
  • Pediatric and family nurse practitioner services
  • Nurse-midwife services
  • Federally qualified health-center (FQHC) services and ambulatory services
  • Early and periodic screening, diagnostic, and treatment (EPSDT) services for children under age 21

Complete your application for Medicaid coverage here

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