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.
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.
Blog: New Omnibus Opioid Law Contains Medicaid Fix for Justice-Involved Youth (January 2019)
Fact Sheet: Medicaid Coverage of Inpatient Psychiatric Treatment for Individuals Under 21 (September 2018)
Fact Sheet: Children’s Mental Health Services: The Right to Community Based Care (August 2018)
Blog: Network Adequacy for Behavioral Health Services in Medicaid Managed Care (June 2018)
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.
- Comments: Comments on the Development of a CMS Action Plan to Address the Opioid Epidemic (October 2019)
- Blog: Medication-Assisted Treatment for Inmates Can Slow Down the Opioid Epidemic (July 2018)
- Issue Brief: Medication-Assisted Treatment for Opioid Use Disorder: The Gold Standard (May 2018)
- Issue Brief: Medicaid and the Affordable Care Act: Vital Tools in Addressing the Opioid Epidemic (February 2017)
- Fact Sheet: Substance Use Disorders in Medi-Cal: An Overview (January 2019)
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.
- Fact Sheet: Mental Health Parity Compliance in Medicaid (January 2018)
- Blog: The Vital Fight for Behavioral Health Parity for LGBTQ People (June 2018)
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.
- Principles: Taxonomy and Principles for Behavioral Health System Integration Redesign (November 2019)
- Principles: Draft Minimum Consumer Protections and Safeguards for Behavioral Health System Integration Redesign (November 2019)
- Issue Brief: Overview of Medi-Cal’s Behavioral Health System & Necessary Safeguards for an Integrated System (October 2019)
- Issue Brief: An Overview of Physical and Behavioral Health Integration (October 2019)
- Issue Brief for The Commonwealth Fund: Assessing Changes to Medicaid Managed Care Regulations: Facilitating Integration of Physical and Behavioral Health Care (October 2017)
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.
- Blog: Trump Budget Takes Aim at Medicaid, Threatens Access to Quality Mental Health Care (February 2020)
- MACPAC Public Comment: Medicaid IMD Exclusion (June 2019)
- Issue Brief: Policy Implications of Repealing the IMD Exclusion (April 2018)
- Comments: Idaho Behavioral Health Demonstration Waiver (February 2020)
- Comments: Indiana SMI/SED Waiver Amendment (October 2019)
- Comments: DC Behavioral Health Waiver (July 2019)
- Comments: Utah 1115 IMD Demonstration (September 2020
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.
- Blog: Setting the Facts Straight on Mental Health and Gun Violence (September 2019)
- Issue Brief: Protections for LGBTQ People with Behavioral Health Needs (June 2019)
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.
- Fact Sheet: Evaluating Mental Health Plans’ Provision of Medi-Cal Specialty Mental Health Services (December 2019)
- Blog: Mobile Crisis Intervention: A Critical Part of CA Continuum of Care for Children and Youth with Mental Health Needs (May 2019)
- Fact Sheet: Monitoring Plan’s Provision of Mental Health services to Medi-Cal Beneficiaries (March 2019)
- Issue Brief: Substance Use Disorders in Medi-Cal: An Overview (January 2019)
- Issue Brief: Navigating The Challenges of Medi-Cal’s Mental Health Services in California: An Examination of Care Coordination, Referrals and Dispute Resolution (November 2018)
- Report: Access to Mental Health Services for Children with Special Health Care Needs (August 2017)
- Issue Brief: Mental Health Services in Medi-Cal (January 2017)
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:
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 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. 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.