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In States Slow to Expand Medicaid, Coverage Gap Widens

Cropped SingleCare logo By | September 4, 2015

Despite its intention to expand mental health coverage, the scope of the Affordable Care Act is often limited by individual states. One demographic in particular bears the brunt of the costs.

According to Kimberly Leonard’s article for U.S. News & World Report, mental health problems affect as many as one in four adults each year. A 2013 report from the federal Substance Abuse and Mental Health Services Administration shows that 9.6 million adults are dealing with a serious mental health disorder.

And in spite of this alarming prevalence, a Field Poll conducted for the California Healthcare Foundation found that only 66% of women and 57.8% of men with a serious mental illness receive care.

While the stigma associated with mental health disorders may be what’s preventing some from seeking treatment, for many others, a lack of coverage is the main barrier to help. Technically, Obamacare covers “behavioral health,” which encompasses individuals with substance abuse or mental health issues, but ambiguities in the law prevent some from getting help with their psychiatric problems.

Medicaid and State Gridlock

The Affordable Care Act helps fund Medicaid coverage for individual adults under 65 who make less than 133% of an income at the federal poverty line, covering much or all their healthcare costs. But these rules apply only in states that are expanding their Medicaid coverage.

A recent Supreme Court ruling determined that the Affordable Care Act’s provision concerning Medicaid expansion must be enforced on a state-by-state basis. That means that in certain states, the government has stalled expansion, leaving around five million people in a coverage gap.

Experts claim the majority of those lost in the gap require mental health treatment. As of July 2015, research presented by Families USA shows that 20 states have yet to expand the scope of mental health coverage.

The Congressional Budget Office forecasted that 13 million Americans without insurance would gain access to coverage by 2014 via the private market, online exchanges, or Medicaid. However, demand has plateaued in the face of steep costs and concerns over the nature of coverage.

“There’s a perception that enforcement is not what it should be, says Bob Carolla, spokesman for the National Alliance on Mental Illness. “People aren’t getting the benefits they are entitled to.”

States of Disarray

Officials at the Office of the Assistant Secretary for Planning and Evaluation predicted that Obamacare would provide 1.2 million people in small group plans with substance abuse counseling and mental health treatment. However, because of the Medicare wiggle room given to providers and states, people have not flocked to receive mental health care in the same way they have to seek treatment for physical ailments.

The Affordable Care Act requires that plans on the insurance exchange cover ten “Essential Health Benefits,” including substance use and mental health disorders, but doesn’t specify which precise services the plans can cover.

Without a clear designation, states have the authority to interpret which procedures count as benefits under Medicaid and which ones don’t. As a result, some insurance plans can use variable standards and evasive language to avoid providing comprehensive behavioral healthcare options.

Filling in the Gaps

Despite its best efforts to be all-encompassing, the Affordable Care Act often leaves much of the authority to shape healthcare provision in the hands of the states. As a consequence, many people who need treatment for mental health or substance abuse still can’t access it.

Luckily, SingleCare offers a solution to this ongoing dilemma. This straightforward service provides its members access to a database of care providers and the rates they charge for specific procedures. SingleCare pre-negotiates discounted rates so that you can find the exact mental healthcare you need for sometimes as much as 60% less than the uninsured rate.

Best of all, SingleCare is not insurance, so there are no expensive monthly premiums or high deductibles to cause stress to you or your financial resources.

Don’t get lost in the loopholes — find a way out with SingleCare.

(Main image source: Wikimedia)