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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