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For some people with disabilities and limited incomes, Medicaid may be their only resource for health care. But if they need mental health care, they’ll find that coverage is limited. Medicaid requires a 50 percent co-payment on outpatient treatment and has other limitations.

Medicaid is financed jointly by federal and state government to pay some of the costs of medical and long-term care for eligible individuals. States must provide basic services, such as doctor visits, hospital care, lab services and some mental health care. States may provide limited optional services as dental and vision care, and prescription drugs.

Who can receive Medicaid benefits?
Medicaid serves some low-income individuals and families, certain elderly people and people with disabilities. Others may qualify. Eligibility rules vary widely from state to state and are determined in part by income, resources, and disability status. Disabled individuals who qualify for SSI disability may be eligible. State agencies determine their own coverage, services and rates under federal guidelines.

Medicaid and mental health coverage
State Medicaid plans are not required to provide psychological services and coverage for these services varies from state to state. Some states cover services by a licensed psychologist or social workers, others cover only psychological services offered at clinics, hospitals, or community health centers. Some cover only evaluations but not treatment; some cap coverage at only a few hundred dollars or a few visits per year. Coverage of services for children is more comprehensive. For a comprehensive look at state coverage, see State Profiles of Mental Health (U.S. Dept. of Health and Human Services, 2003) .

In recent years, coverage of psychological services in many states has been reduced in cost cutting measures. Many states also restrict access to certain types of drugs, including those for mental health conditions. States may require prior approval for certain drugs or the use of generic drugs or limit the number of prescription drugs that can be filled without prior approval.

Many states are joining together to buy medications at a reduced cost and are establishing a limited list of 'preferred drugs' for Medicaid recipients. But, about half of states have established exemptions for mental health medications.
Mental health advocacy organizations such as Mental Health America (MHA) and the National Alliance on Mental Illness (NAMI) are advocating against limitations on these medications.

Laura Galbreath, Senior Director of Healthcare Reform of Mental Health America, says, "Mental Health America works at the federal level and with state/local affiliates to ensure that individuals have access to mental health treatment including mental health medications.At the federal level we continue to work on medication issues in Medicare. We are also working to bring parity to Medicare, she says.

"One of the primary barriers to mental health care for Medicare beneficiaries is a 50 percent co-insurance rate imposed on outpatient mental health treatment, instead of the usual 20 percent co-insurance charged for other outpatient services."

The position held by NAMI the is that "These strategies may pose significant health threats for Medicaid recipients with mental illnesses trying to access medications prescribed by their treating physicians."

For more information about Medicaid policies that limit coverage of mental health drugs, visit Mental Health America and the National Alliance on Mental Illness.

For more information about Medicaid, visit the Centers for Medicare and Medicaid Services

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Sources
American Psychological Association
Mental Health America
National Alliance on Mental Illness

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