Millions of people in the United States cannot afford private insurance and do not get group insurance through their employers. Medicaid was created to address this issue by providing low-income families with the coverage that they need.
In February 2020, 70,568,148 citizens were enrolled in the Medicaid and Children's Health Insurance Program (CHIP) in the US. Because the programs serve low-income people, some perceive that Medicaid benefits are inferior to private insurance, particularly when it comes to mental health. In reality, Medicaid is the biggest payer in the US for mental health treatments, including addiction treatment, and often meet federal standards that guide all healthcare policies.
Mental health benefits used to be inferior to those of medical/surgical benefits in most health insurance. However, the Mental Health Parity and Addiction Equity Act of 2008 mandated that most insurance policies must offer mental and behavioral benefits equal to those for other conditions. These provisions apply to copays, coinsurance and out-of-pocket maximums, medical necessity criteria and limits on outpatient visits and inpatient care days. If you have a Medicaid policy, you should be charged the same copay for a covered mental health visit as you are for a covered general practitioner's visit.
Medicaid services are run by the individual states, and although mental health benefits differ, all of these programs provide some mental health coverage. Some states offer excellent substance use treatments as well. The Children's Health Insurance Program offers numerous mental health services, including therapy, counseling, behavioral health, medication management, peer support and more. So while states can determine their own mental health benefits for adults, the federal government mandates a higher level of treatment options for children.
Those states that have entered the expanded Medicaid programs must offer a higher level of mental health benefits (those prescribed by the ACA) than those that reject the program. In addition, expanded Medicaid allows previously unqualified people to get coverage. For instance, childless adults are now covered.
Expanded Medicaid also relaxes income requirements. People who earn 133% of the poverty level are eligible for coverage and their health and family status are not factors for their acceptance.
Geography does matter when it comes to Medicaid benefits. Not all states provide these expanded benefits, so someone in Missouri will not be eligible for the same level of benefits as someone living in Illinois.
The states that have rejected expanded Medicaid include: South Dakota, Wyoming, Kansas, Oklahoma, Texas, Missouri, Wisconsin, Tennessee, North Carolina, South Carolina, Georgia, Alabama, Mississippi and Florida. Many of these states have large low-income populations that need the affordable access to mental health and addiction services that expanded Medicaid provides.
When shopping for a Medicaid plan, it's important to study its mental health and substance abuse benefits. Be sure to check both their level of inpatient reimbursement as well as their group and individual counseling benefits.
Policies that cover mental health benefits will not reimburse visits unless the insurance company deems them medically necessary. Medical necessity determinations vary between insurance companies, but as long as your counselor states you need treatment, most claims will be accepted.
Under parity rules, you are entitled to as many visits as you need. In the past, patients were sometimes limited to six visits a year or some other random number. Since your insurance policy doesn't limit other medical office visits, it cannot limit your mental health visits either.
All Medicaid policies must now include some mental health benefits, but under standard Medicaid, these benefits are determined by the state, and state requirements vary greatly. Under expanded Medicaid, states must offer a higher level of benefits to their citizens. If you live in an expanded Medicaid state, you should have access to the mental and behavioral health services that you need. Plus, you can earn more money annually and still be eligible.
Those who live in states that have rejected expanded Medicaid will receive fewer benefits and must be at poverty level to receive those. Mental health services in the US depends to a large degree on geographical location. Before moving out of state, you should research that state's medical and mental health coverage.
Experts urge you to be vigilant about any policy's mental health benefits. Chances are that someone in your immediate family will need to see a counselor about a mental health or substance abuse issue in the next few years. No matter your income level, you need to be prepared.