Is Your State Participating in Medicaid Expansion?

Let’s look at Sarah, who lives in Tennessee, and Elizabeth, who lives in Kentucky. Both have major depressive disorder, but both are working the maximum number of hours allowed at a mega-store. Even so, they barely stay afloat financially. Their employer does not provide health insurance to them, although if the company made it available, Sarah and Elizabeth would not be able to cover the premiums and deductibles. But Elizabeth can get subsidized health insurance–and mental health care–while Sarah cannot. Why? Read about it in this third post in our series on funding mental health care.

Depression and bipolar disorder—the two most prevalent mental health conditions—affect more than 21 million Americans. Untreated, these and other mental health conditions can exact a huge toll on the American economy:

  • Loss of productivity from mental health disorders costs $63 billion each year
  • Unemployment rate for adults living with mental health conditions is 3-5 times higher than for those without a mental health condition
  • Major Depressive Disorder is the leading cause of disability in the U.S.

Yet these conditions are highly treatable for individuals who are willing and able to access care. There are many reasons why people may not access treatment for a mental health condition, but affordability of care should never be one of them. In a recent issue brief published by Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation (ASPE), the authors revealed that over half of individuals who felt they needed treatment for a mental health condition did not receive that treatment due to cost.

Making affordable care accessible
Fortunately, there are ways for most Americans to access and receive mental health care through the Affordable Care Act. Often known as Obamacare, this law has some key features that remove cost barriers that can be associated with an insurance plan.

  • There are no lifetime limits to care
  • Pre-existing condition clauses are illegal
  • Young adults can stay on their parent’s insurance policy until age 26.

But what about people who want care yet are unable to afford the ACA subsidized premiums? Anticipating this issue, the framers of the Affordable Care Act thought to allow individual states to expand Medicaid, thereby including most individuals whose income is up to 138% of the federal poverty level. Known as Medicaid Expansion, it is making a difference in the 32 states to date that have opted to participate in this program. According to a U.S. Government Accountability Office (GAO) report, Medicaid expansion resulted in greater availability of mental health treatment for previously-uninsured individuals.

In fact, presidential candidate John Kasich shared that his own family experience with mental health issues was a major factor behind his decision to support Medicaid expansion as governor of Ohio.

Building the case for Medicaid Expansion
Untreated or under-treated mental health conditions can lead to lower economic stability. Therefore, it is not surprising that people with mental health and substance use disorders account for 28% of low-income/uninsured people in non-Medicaid expansion states. Further, only 11.5% of low income/uninsured individuals receive behavioral health care. However, this same report reveals that low-income individuals are 30% more likely to receive treatment if Medicaid coverage is available to them. (ASPE issue brief March, 2016)

States that focus on whole health and wellness understand that an investment in mental health can provide an immediate payback to their state’s budget. Although individuals living with a mental health condition also often experience physical health conditions, the costs associated with the ongoing medical care can be reduced by treating the co-occurring mental health condition. For example, the overall medical costs for individuals living with both diabetes and depression can decrease significantly when the depression symptoms are effectively treated and managed.

Access to care can lead to additional side benefits. According to the United Kingdom, National Health Service, almost 50% of long-term absences from work are due to a mental health issue. Yet the NHS shares that returning to work after treatment leads to an improvement in health and wellbeing. Here in the U.S., the federal government agency SAMHSA supports getting individuals back to work through program grants for supported employment—paid employment from a real business that is participating in the program. In fact, 58% of individuals participating in supportive employment programs secure competitive employment at some point over a 12-18 month period.

Know the candidates’ positions
There are long-term economic gains for both the governments that fund mental health programs and the people who use them. By making insurance for health care affordable and available, Medicaid expansion enables people to be healthy and lead self-defined lives of wellness. Medicaid expansion accounts for the difference between our fictional Sarah and Elizabeth, as Sarah lives in Tennessee—one of the 19 states that has not opted in to Medicaid expansion.

When evaluating candidates for national, state, and local elected offices, do the research, learn where they stand on programs that support all people accessing mental health care, and share that information with other voters.

Your Turn

  • How will you hold candidates accountable for discussing mental health funding during this election season?

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