Children's advocates are pressing California lawmakers to pass a bill that would increase oversight on health plans when they deny mental health services for children. Right now, parents have to ask their health plan for a review when a child's mental health condition isn't covered by their insurance - and if service is still denied, they can ask the state for an independent medical review.
Lishaun Francis, senior director of behavioral health with the nonprofit Children Now, a sponsor of the bill, said this is a critical issue.
"This bill says if plans deny care for a Youth Mental Health Service, they have to automatically review that denial, as opposed to a parent calling and asking them to take a second look. If it is an emergency service, that review goes to the state automatically," she explained.
The California Association of Health Plans opposes the bill, arguing that the extra reviews could delay care and build more unnecessary costs into the health care system. Case stories posted on the state's Department of Managed Health Care website suggest the types of services most commonly denied by health plans include residential mental health treatment, and medication or surgery for gender dysmorphia.
Francis said when parents escalate their fight to an independent medical review, they often win.
"Almost 70% of all claims that make it to the state get overturned by the independent medical review process, which tells us a big chunk of this is something that health plans should actually be covering," she said.
Senate Bill 294 would also require the state to make public the number of independent medical review claims they receive each year, and how they were resolved. The bill has already passed the state Senate, and is now before the Assembly Committee on Health.
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Some 125,000 children in Michigan struggle with major depression, which can hinder learning, behavior and relationships, according to a recent survey. Research shows the benefits of school-based services to connect them with the care they need.
Together with parents, school mental health resources can help keep kids safe.
Scott Hutchins, who manages the behavioral health unit for the Michigan Department of Education, stresses the importance of these services, especially in light of the pandemic and school shootings.
"Those needs have only been exacerbated since COVID and those other violent tragedies," he said. "So, what mental-health services do is, they allow us to break down the barriers that students need to get the care that they need."
However, the state needs more of these professionals. Michigan has one school psychologist per almost 2,200 students. The recommended ratio is one for every 500 students. The state also requires school districts to include suicide-prevention hotline contact information on IDs for students in grades 7 through 12.
Statistics show youths receiving school-based mental-health services are six times more likely to complete treatment than those receiving community-based services.
Angela Kimball, chief advocacy officer for the nonprofit mental health advocacy group Inseparable, noted that funding is one key challenge in expanding the school mental-health workforce.
"In order to become a licensed professional," she said, "you not only have to pay for schooling, but there's also periods of supervision - where people are essentially working for free and having to pay for supervision as they work towards their credentials."
Kimball said groups like hers are pushing for policies to improve staff ratios and encourage people to consider mental-health careers. In the meantime, if you or someone you know is in crisis, call 988 to be connected with a trained counselor, available 24/7.
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About half of youths experiencing depression in Illinois are not receiving treatment. While the state ranks fairly well nationwide when it comes to youth mental health, officials say there is room for improvement.
Andrea Durbin, CEO, Illinois Collaboration on Youth, said anxiety and depression are at an all-time high, especially with LGBTQ youths and those in immigrant families.
"This is a time for us to be compassionate and empathetic and to embrace folks who are feeling this way and to be supportive, and understand where this is coming from and what our responsibility as adults is to protect them," she said.
The state's Children's Behavioral Healthcare Transformation Initiative passed in 2022. It emphasizes the importance of proactive mental-health screening in schools, similar to vision and hearing tests. Now, a new state law requires yearly mental-health screenings for seventh through 12th grade students.
Despite this progress, barriers to community-based mental-health services for youths still exist and include cost, transportation, insurance issues and stigma.
Angela Kimball, chief advocacy officer with Inseparable, said school-based services that provide different levels of support are one of the most effective tools for supporting student mental health and improving access to care.
"We are starting to see some improvements in student mental health, and that's very encouraging, but the need is still very, very high," she explained. "So we can't let our foot off the pedal now. We really need to do everything we can to build the workforce and to make sure students are supported."
She said youth who get school-based services are six times more likely to complete treatment and have improved long-term education and work outcomes. Yet currently, most state schools don't have the recommended ratio of mental-health staff to students. State-funded programs such as the Behavioral Health Workforce Center are working to address the provider shortage. Kimball added that state policies and initiatives that continue to provide solutions to any roadblocks to mental-health services are crucial to providing youths the care they need.
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More than 3 million New Yorkers have a diagnosed mental illness but only around one in three can get the care they need to treat it.
The barriers stem from many factors, like so-called "fail first" policies, which require people to try an insurer-preferred medication first, before covering the original prescription.
Matthew Shapiro, senior director of government and cultural affairs for the New York State Chapter of the National Alliance on Mental Illness, said another issue is what are known as "ghost networks."
"In some cases, up to 75% of providers that the insurance company gives to their client don't actually exist," Shapiro pointed out. "They're no longer practicing in the area. We call that 'ghost coverage,' where they're telling you coverage is there and it's not."
A 2023 New York State Attorney General report found 86% of providers listed on health plan networks are not valid listings. The report recommended state regulators crack down on insurers to maintain consistent and accessible levels of care for all. Another barrier is low mental health care reimbursement rates for providers.
As mental health issues rise nationally, insurance coverage needs to meet the moment. Federal laws like the Mental Health Parity and Addiction Equity Act and the Affordable Care Act ensure behavioral health coverage is on par with other health care.
David Lloyd, chief policy officer for the mental health advocacy organization Inseparable, said loopholes in the laws still have to be closed.
"What mental health advocates across the country and in states are pushing for is to make sure when a doctor is recommending treatment, the health plan has to cover those services when they're consistent with what the standards of care are," Lloyd explained.
The biggest challenge to closing loopholes is lawmakers finding the political will to do so. Lloyd added the overall goal is to align providers' and insurers' standards of care, so patients get the treatment they need.
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