How health care reform will affect mental health

by Diana E. Lee

The cost of therapy and medication for underinsured people are common barriers keeping people from getting treatment for a mental health problem.

Although there are community mental health centers that provide treatment for many people, their resources are stretched far too thin to help everyone who needs treatment on the level someone with a more serious issue may need. One of the most positive changes that will arise out of the recent passage of health care reform legislation is that more people will have access to affordable, effective treatments for their mental health needs.

* More people will be eligible for Medicaid or get financial help purchasing private insurance. The law provides tax credits for some low-income Americans to help them meet the cost of purchasing insurance.

* Cheaper drugs will be made available for people on Medicaid and drugs that have traditionally been excluded from Medicaid coverage will now be eligible for a federal Medicaid match equivalent to what these medications cost the states.

* Prescription drugs for those covered by Medicare (the elderly and disabled) will become more affordable as the donut hole is closed. The donut hole is the gap between the initial drug coverage and catastrophic drug coverage provided by Medicare in which patients are required to pay for their own medications. The law also requires Medicare Part D prescription benefit plans to cover drugs in every category of medication, including mental health prescription drugs, such as antidepressants and antipsychotics.

* This legislation ends the common practice of not selling insurance policies to people with pre-existing conditions. This change will end any disincentive to seek treatment for fear you will be labeled with a diagnosis and denied insurance in the future and will help people get insurance who have already been diagnosed with a mental health condition.

* The legislation extends the Wellstone Domenici Parity and Addiction Equity Act to apply to any plan included in the health insurance exchanges, including all individual and group insurance policies. The Wellstone Domenici Act only applied to group employer insurance plans for employers with more than 50 workers. It did not apply to Medicare, but did apply to Medicare managed care plans. In addition, the Wellstone Domenici Act did not require plans to provide any mental health benefits. Rather it said if a plan provided mental health benefits they had offer the same benefits for mental health as for physical health.

* Insurance providers will be required to provide a minimum basic mental health benefit.

* Individuals with pre-existing conditions will have immediate access to insurance through high-risk pools.

* The new law eliminates annual and lifetime limits on mental health (and physical health) benefits.

* The range of Home and Community Based Services (HCBS) offered to people with disabilities who require long-term care, but do not wish to be institutionalized, will be expanded. States will also be allowed to target these services toward specific groups, such as people with serious mental illnesses.

* National Depression Centers of Excellence will be established and funded with 5 year grants. These institutions are intended to promote increased access to the best interdisciplinary, evidence-based care for people with depression, disseminate research and establish treatment guidelines.

Diana E. Lee is a chronic migraine patient who blogs at Somebody Heal Me.

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  • Dr. Matthew Mintz

    I was a proponent of passing the current health care reform legislation and believe that expanding coverage and eliminating pre-existing conditions are good things.
    However, the current legislation will do very little to improve mental health in this country, with the exception of expanding coverage.
    Poor patients with Medicaid and even patients not so poor with good health care insurance have an extremely difficult time getting the mental health care they need. This is because the reimbursement rate for mental health care services is ridiculously low. So many mental health care professionals no longer accept insurance, that finding a mental health care provider that does take your insurance and accepts new patients is almost impossible.

  • stargirl65

    Will they pay primary care doctors to provide mental health care?

    Currently if I put down any mental health ICD code I won’t get paid a cent for the visit. This will happen if they came in only for mental health problems. It will also happen that they will deny the entire visit even if mental health was only a small part of a visit (that included other problems such as htn and dm). This game by the insurers also make sure that mental health is underreported. My office NEVER puts down a mental health diagnosis. We want to get paid for our time.

  • Wellescent Health Blog

    This is not a problem simply for the US. In Canada, access to mental health services is also difficult even in a system often described as providing socialized health care. In general, it seems difficult for doctors to charge for mental health services. My guess is that this is because both the conditions and the outcomes are difficult to nail down in comparison to other medical conditions and treatments.

  • David Allen, MD

    Good luck expecting socialized health care to do better than the (half) private current system! As things get worse in health care, as the bottom line looms large for government bean counters – expect non-tangible, difficult to measure things like pain and mental health to fall by the wayside. I see many patients who are in the hospital, in horrible pain (from migraine, cervical radiculopathy, etc.) who, I am informed by case managers, ‘do not meet criteria for hospitalization’. In other words, the hospital wants them out because the insurance companies (including Medicare) won’t pay for the admission. In addition, I find if VERY DIFFICULT to get timely psychiatry consultations in the hospital – and this doesn’t seem to be related to insurance at all – it doesn’t matter if they are insured. Psychiatrists have simply figured out that insurance payments are not worth it for them – and in many cases, they have opted out of that whole system.

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