Mental-health coverage now required, but access is limited; Medicaid share of all new Ky. enrollments is 85 percent

More people in Kentucky and the nation have access to mental-health care than ever, because of the Patient Protection and Affordable Care Act, but that doesn't mean the care is quick or abundant, especially for those on Medicaid, Abby Goodnough reports for The New York Times.

In the latest of a series of stories Goodnough is doing about health reform from the Louisville area, she gives a new figure for the share of Medicaid patients in the rolls of the 521,000 newly insured Kentuckians: 85 percent. When the regular enrollment period for private insurance ended this spring, the figure was 75 percent, but Medicaid enrollment is open year-round.

The reform law requires mental-health treatment to be covered by Medicaid and every private plan sold through the state's online insurance marketplace, The intent of that, Advocates told Goodnough, is to not only reduce suffering, but also to reduce other health problems and the resulting expense and lost productivity.

Kentucky recently allowed private psychologists and social workers to accept Medicaid patients, adding more than 1,000 private mental health providers to the Medicaid list, state officials told Goodnough. Previously, only "quasi-governmental agencies" were approved to treat Medicaid patients in Kentucky.

"But shortfalls in care persist," Goodnough writes, telling several stories of the successes and challenges that people on Medicaid in the Louisville area who now have mental health coverage are facing. One of the people she interviewed is Terri Hall.

Hall suffers from depression and anxiety that "often consumed her," Goodnough writes. Since she got Medicaid coverage, she is now getting therapy for the first time, but she "just wished she could go more often." She tells Goonough that she has had to wait up to seven weeks between appointments at Seven Counties Services. This is a common story among the people Goodnough interviewed.

Another challenge to mental-health access is that many private therapists, like some of their physician counterparts, refuse to accept Medicaid. Medicaid pays, on average, about 66 percent of what Medicare does, and some therapists say "the paperwork takes too much time and the poor ? who often experience more violence and trauma than those who are better off ? are too challenging to treat," Goodnough reports.

In addition to low reimbursement, private providers struggle when they take on Medicaid patients because they have to wait to be approved by the managed care companies that provide benefits to Medicaid recipients, Goodnough writes.

With nearly one in five Americans having a diagnosable mental illness, according to the Department of Health and Human Services, but most getting no treatment, Goodnough writes, the new health law offers "a big opportunity for mental health providers to reach more people of all income levels," especially the poor in states that have expanded Medicaid.

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