Mental Health, Autism Spectrum Patients Struggle To Get Health Care Coverage

Americans suffering from mental health disorders often face difficulties finding the coverage they need.
By @MMichaelsMPN |
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    One in five American adolescents — comprising up to 12 million individuals — experiences a mental health disorder each year, according to a study released earlier this year by the Center for Disease Control. As diagnoses increase, so do the costs for treatment, which stand at roughly $247 billion each year, according to the same study.

    This trend occurs as an increasing number of youth are diagnosed with autism and other developmental spectrum disorders (ASD). Mental health disorders and ASD are classified and treated differently but the underlying difficulty in receiving treatment means that without consistent and comprehensive health care coverage, a generation of youth will continue to rely upon costly emergency care or be denied treatment altogether for a range of issues.

    “How much has it cost to not treat mental health conditions? Not treating them has led to overall higher health care costs, because people often wait until they are in crisis to get costly treatment in emergency care,” said Debbie Plotnick, senior director of state policy for Mental Health America, in a statement to Mint Press News. “It will help a great deal, to treat these problems earlier. We also know that people often have a co-occurrence of more chronic types of conditions. Treating these early should again help bring costs down, not up.”



    For Tara McCoy, a graduate student in psychology from Riverside Calif., the struggle to obtain assistance for her autistic brother has left her family with few options. Even obtaining a test that can properly diagnose her brother has been difficult and prohibitively expensive.

    “There are specific tests that are considered more valid for autism spectrum disorder. He was not properly diagnosed and that was frustrating,” McCoy said in a statement to Mint Press News.

    “He’s uninsured and we need to get him properly diagnosed. I spoke to someone at ARC, which is an autism resource center, and they said it could cost $800 or more to get the correct tests. I was doing research in California and clinical psychologists charge by the hour. Some are more than $150 per hour,” she explained.

    California’s public health Medi-Cal program for low income residents and those lacking insurance has repeatedly denied McCoy’s brother the service he needs. “We’ve applied for Medi-Cal and my brother was denied,” she said. “Although all of his possessions were here in California, he was denied service because he was in Minnesota visiting family at the time of his application. They said he was denied approval because he was not in California at the time of the application. We are going through the process, trying to re-apply.”

    The Los Angeles Times reported in July that California is in the process of phasing out its Healthy Families insurance program, shifting nearly 900,000 children it covered into Medi-Cal. The Healthy Families insurance program provided services to autistic children, including therapy. For many families who won’t be covered by Medi-Cal, the out-of-pocket expenses will be too costly.

    “I’m afraid he’s not going to make any progress from now on,” said Jenny Kim, a mother who would have to pay $10,000 a month in order for her son to receive the same behavior therapy once covered by the Healthy Families Program.

    Autism is a developmental disorder that affects social skills for about 1 in 88 American youth, according to Autism Speaks, an advocacy website. Symptoms appear as early as age 3. McCoy’s brother is now 21, but because he is attempting to get a diagnosis after his 18th birthday, it’s been all the more difficult to obtain services. Many agencies deny help to autistic youth over the age of 18 in California.

    “Some states do a great job, some not so well. Some of the best advocates bar none are parents. Often the parents don’t want to consider it part of general mental health. What is autism? It’s a spectrum disorder, it’s not something that develops or just happens,” Plotnick said.

    “My brother doesn’t work, he doesn’t go to school. He sits at home and plays video games all day. So trying to help him figure out what he wants to do with his life is important. A case manager can do that,” McCoy added. “A case manager would be provided through a government resource center. It’s definitely impacted my time. I feel like I have a child now. I have to tell someone what to do — tell him when to shower, when to get dressed. I have somebody asking me ‘what’s for lunch?’ ‘What’s for dinner?’ Now I am taking care of someone else. I am a graduate student in psychology, that is already like a full-time job in itself.”


    Mental health

    It’s been a similarly difficult path for many who have tried to obtain assistance for mental health disorders, which up until recently have been ignored by many health insurance companies that have simply refused coverage to those suffering from a range of diseases, including depression, schizophrenia and substance abuse issues.

    “Our best understanding is that about 1 in 5 people will have behavioral disorder in any given year, including substance abuse disorders. … Included in there are substance use conditions. Sometimes people self-medicate and start using illegal drugs to deal with some underlying issue.” said Plotnick of Mental Health America, a 104-year-old mental health advocacy organization, the oldest in the U.S. The organization has affiliates in 41 states that provide services and are all to some degree advocacy organizations.

    “Many people are self-medicating. We are also able to understand certain mental health issue better than we used to,” Plotnick said.

    Mental health advocates are hoping for a big breakthrough by the end of the year, when the 2008 Mental Health Parity Act (MHPA) will go into effect.

    In 2008, the MPHA established an important rule claiming that health insurance companies must treat mental health as they would any other disorder. The law is considered a crowning achievement of the late Sen. Paul Wellstone’s (DFL-Minn.) career and could soon close loopholes in the Mental Health Parity Act of 1996.

    “It’s going to change big time. Up until the very last few years, insurance companies have been able to and have been saying, ‘We are not going to cover mental health issues’ — or they will set higher thresholds, a lifetime limit or, let’s say, 30 visits per year,” Plotnick explained.

    Although it has been law for nearly five years, the MHPA has been operating on a set of interim rules. Final rules that will require health insurance companies to treat mental health issues the same as physical ailments should go into effect by the end of the year, extending coverage to 82 million Americans who currently do not have proper coverage, according to one estimate by the American Psychological Association.

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