Mental health coverage still lagging in N.H.

Monitor staff

In 2014, the Affordable Care Act made it so all small group and individual insurance plans had to cover mental health services as they would a regular doctor’s visit.

Two years later, a report from the National Alliance of Mental Illness found that accessibility to mental health services still lags in the United States because there are too few psychiatrists. It also found that costs for treating mental health remain high, with some insurance reimbursement rates too low for mental health professionals to participate in the networks.

“I think a lot of the issues in the report are very much the realities in New Hampshire,” said Susan Stearns, director of philanthropy for NAMI New Hampshire.

Stearns, who is well-connected in the state’s mental health community, said even she has had difficulty helping her loved ones find providers.

In one case, Stearns said it took more than six months for a family member who had insurance to find a mental health provider with an opening in their practice.

“It was kind of mind boggling to me,” she said. “The capacity, just plain the number of providers we have and how busy their practices are is probably what I hear most.”

The national report from NAMI surveyed over 3,000 individuals, asking them questions about getting care for mental health or substance use disorder and how that compared to getting primary care.

The survey results found that mental health prescribers and therapists were far less likely to be covered by insurance than their medical counterparts.

Twenty-seven percent of mental health therapists were not covered by insurance, the report found, while 24 percent of psychiatric providers were also not covered. Compared to that, just three percent of primary care providers and eight percent of specialty medical providers were not covered by insurance.

Out-of-pocket costs were also higher for mental health care than medical care, the study found.

Seventeen percent of patients had to pay out-of-pocket expenses over $200 for psychiatry visits and 15 percent paid the same amount for therapists.

That is more than double the number of people who had to pay high out-of-pocket costs for primary care – six percent.

The price tag for therapy is not cheap. It can range from around $75 to $200 for those without insurance.

And as Stearns points out, therapy is ongoing, so those costs can be incurred weekly or bi-weekly.

Politically, it’s an uncertain time for the Affordable Care Act. With President-elect Donald Trump and the Republican-controlled Congress in power, there are threats to repeal and replace the federal health care law.

Stearns said she is concerned the law’s potential repeal could affect people who weren’t able to access insurance for mental health services until the Affordable Care Act.

She and many others are waiting to see how the changes could affect New Hampshire’s expanded Medicaid program and the substance use disorder benefits it allows low-income patients to access.

“It’s a complex piece of legislation to try and keep some balance,” she said. “If you lose some pieces of it, you lose some of that balance.”

Even with the Affordable Care Act in place, the situation is far from ideal. Wait times, high costs and a lack of providers are contributing to more New Hampshire residents needing mental health care finding themselves stuck in emergency rooms as they wait for a bed to open up at the state hospital.

By the time someone realizes they need to see a mental health specialist, “they’re probably pretty much in crisis,” Stearns said.

The national NAMI report on mental health also issued several recommendations aimed at giving people more information about insurance and available providers in their state.

The recommendations include requiring insurance providers to keep up-to-date directories of their providers and provide consumers information that’s easy to understand about what their plan covers.

Information is key, Stearns said.

“It’s not really clear sometimes to folks as to what their coverage is,” she said. “It can be complex to figure out.”

The report can be found at nami.org/parityreport.

(Ella Nilsen can be reached at 369-3322, enilsen@cmonitor.com, or on Twitter @ella_nilsen.)