Behavioral Health

Advancing Access to Quality, Community-Based Behavioral Health Services for Low-Income Individuals

NHeLP works to ensure that quality behavioral health services and supports are readily accessible where and when people need them. “Behavioral health” encompasses both mental health and substance use disorder services. NHeLP’s unique approach to behavioral health advocacy uses the entitlements guaranteed by Medicaid and the Affordable Care Act (ACA), and the rights ensured by the ADA and other civil rights laws, to promote access to quality, community-based services and supports for low-income individuals.

  • Medicaid is the single largest payer of behavioral health services. Furthermore, Medicaid’s Early & Periodic Screening Diagnostic and Treatment (EPSDT) entitlement for children and youth is intended to ensure children are screened and assessed early for their behavioral health needs, and receive the effective services and supports in a timely manner.

  • The ACA expanded behavioral health coverage, and the requirements of parity, to millions.

  • The ADA requires people with disabilities, including mental health and substance use disorders, be served in the most integrated settings to meet their needs.
A young man sitting on the ground at a park, meditating.

Mental Health Services

Low-income children and adults all too often cannot access quality mental health services in their own communities. NHeLP works to dismantle barriers to care and advocates for robust coverage of, and timely access to, effective home and community-based mental health services and supports.

Substance Use Disorder Services

The vast majority of individuals with SUD are currently not receiving  medication-assisted treatment, despite its demonstrated effectiveness. Recognizing that Medicaid and the Affordable Care Act are vital tools in the fight against the overdose epidemic, NHeLP advocates at the federal and state level for comprehensive Medicaid coverage of life-saving treatment without restrictions and access to evidence-based SUD services pursuant to the Affordable Care Act’s Essential Health Benefits provision.

Behavioral Health Parity

Health insurers must provide care and treatment of mental health conditions and substance use disorders on par with the treatment and services provided for other health care conditions. NHeLP focuses on  how these requirements apply to Medicaid and the Children’s Health Insurance Program (CHIP) as we  offer avenues for better implementation and enforcement.

Behavioral Health Integration

Integrating behavioral health with physical health care is a growing national trend. Integration can occur at the multiple levels, from the administrative level (e.g. through fully integrated managed care plans) to the the clinical level, where services are delivered.

 

Woman in healthcare setting talking to her doctor

IMD Exclusion

The Medicaid “IMD exclusion” prohibits federal funding for services provided to residents of mental health and substance use disorder facilities with more than sixteen beds. Because Medicaid reimbursement is available in the community rather than institutions, the IMD exclusion has provided important incentives to states to develop community-based alternatives and to rebalance spending towards more integrated environments. NHeLP analyzes how the IMD exclusion shapes behavioral health systems and promotes community-based alternatives, while charting alternative state and federal pathways for behavioral reform.
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Behavioral Health Equity

NHeLP works to promote equity in the provision and coverage of mental health and substance use disorder services, and to dismantle structural racism and other discrimination within behavioral health systems of care.

Additional Focus on CA

NHeLP’s California office plays a significant role in advocating on behalf of Medi-Cal beneficiaries for more effective and timely access to mental health and substance use disorder services. To that end, we have developed a number of resources for advocates and stakeholders.

Litigation

In partnership with state health advocates, the National Health Law Program litigates on behalf of children, youth and adults with behavioral health needs. Our cases have helped set the standard for quality, community-based behavioral health care. Our cases include:

K.B. v. Michigan D.H.H.S., Eastern District of Michigan

A class of Medicaid-eligible children with intensive mental health care needs who are at risk of avoidable psychiatric hospitalizations or commitment to the juvenile delinquency system sued the Michigan Department of Health and Human Services for failing to provide needed mental health services in the community as required by the Early and Periodic Screening, Diagnostic and Treatment and the Americans with Disabilities Act.

A.A. v. Gee, Middle District of Louisiana

Medicaid eligible children who require intensive home and community-based mental health services challenged Louisiana’s failure to arrange for or provide those medically necessary services. The failure to provide these services has forced thousands of Louisiana children to unnecessarily cycle in and out of hospitals and psychiatric facilities far away from their homes for extended periods of time and has resulted in some children becoming inappropriately involved in the juvenile justice system.

T.R. v. Dreyfus, U.S. District Court, Western District of Washington

This class action lawsuit against the Washington State Department of Social and Health Services (DSHS) was brought on behalf of Medicaid-eligible children under age 21 in Washington State who were denied necessary intensive home and community-based mental health services. The lawsuit also claimed that the state has failed to comply with the American with Disabilities Act (ADA), which requires that public entities such as DSHS provide services to children with psychiatric disabilities in the most appropriate integrated setting.

Katie A. v. Bonta, U.S. District Court for the Central District of California

Katie A. v. Bonta is a class action lawsuit that was filed in July 2002 against California’s State Departments of Health Care Services and Social Services (the state case), as well as Los Angeles County and its child welfare agency (the county case). It challenges California’s failure to provide home-based and community-based mental health services to children who are in or at risk of foster care. A settlement agreement was reached in the state case in 2011 while the county case (Katie A. v Los Angeles County) reached a separate settlement agreement. The settlement required the state to make “intensive care coordination, intensive home based services, and therapeutic foster care available to children on Medi-Cal with mental health needs, to enable them to stay in their own homes and communities.

Katie A. v. Los Angeles County, Central District of California/Western Division

Katie A. v. Bonta is a class action lawsuit that was filed in July 2002 against California’s State Departments of Health Care Services and Social Services (the state case), as well as Los Angeles County and its child welfare agency (the county case). It challenges the State and County’s failure to provide necessary home-based and community-based mental health services to children who are in or at risk of foster care. A settlement agreement with Los Angeles County was reached in 2003 wherein the County agreed to close its large shelter facility for foster youth – MacLaren Children’s Center – and to develop appropriate child welfare and mental health services in the community. An expert Advisory Panel was established as part of the settlement agreement to monitor implementation and assist the County. While one lawsuit was filed against both the State and LA County, this part of the case is known as Katie A. v. Los Angeles County.