Accessing mental health care under the Affordable Care Act

Accessing Mental Health Care

When it was first announced that President Barack Obama was planning to expand health insurance to millions of uninsured Americans, there was a great deal of speculation among the public over what the law would cover. Specifically how mental health care under the Affordable Care Act would evolve. For example, would people gain access to mental health care providers or just primary care physicians? As time has gone on, it has become clear that Americans will have the opportunity to get their mental health services covered by the ACA​. Yet, some remain unsure of how this will work.

The New York Times reported that mental health care was named one of the 10 essential benefits that the ACA would address, and this isn’t the only law impacting people’s access to psychiatric treatment. In November 2013, the government decided to fully implement an older, stalled law called the Mental Health Parity and Addiction Equity Act of 2008. This law mandates  that if health insurance providers offer mental health coverage, they cannot charge people a higher deductible or co-pay to see a psychiatrist than they do for seeing a medical doctor. Furthermore, insurance companies cannot place limits on the number of visits a person can make to his or her mental health professional.

How can people get coverage?
Just because the ACA gives people greater access to insurance that covers their mental health treatment does not mean they will necessarily get in to see a provider. A survey published in the Journal of the American Medical Association found that only about half of psychiatrists take private insurance. This underscores the importance of being cautious when choosing health plans; people should make sure they pick the one that meets all their needs.

For example, The Times explained that when examining different coverage options, people should determine whether there are mental health providers in their area who belong to the network they are considering. Seeing out-of-network providers can result in the health insurance company covering a smaller percentage of the costs than it would otherwise.

Medicaid expansions may help people get care 
The National Alliance on Mental Illness (NAMI) explained that on top of getting mental health care coverage through the ACA marketplace, another option is to access it through a state Medicaid program. The organization stressed that there are currently many Americans who do not have health insurance, but also do not qualify for Medicaid. However, if states expand their programs (and some are), these individuals may then become eligible given the new circumstances.

“Today more than 2.7 million low-income Americans with mental illness cannot get Medicaid even though they have no health insurance. As it stands now, Medicaid pays health costs for a few specific groups, including low-income children under 18, their parents, pregnant women and people with disabilities who get a monthly check though Social Security Income. Medicaid does not cover childless adults unless they have very low incomes and the government has declared them disabled. In some states, even those who meet the disability rules may not qualify due to very strict income rules,” explained the NAMI.

People who can’t find a therapist that accepts their insurance should contact their county behavioral health departments. According to The New York Times, it is the job of workers in this department to help individuals find affordable care. Furthermore, people can turn to the federal Substance Abuse and Mental Health Services Administration, which offers a service on its website that can help them locate places in their area where they can get the treatment they need, regardless of their insurance status.


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