Addressing Barriers to Behavioral Health Coverage for Low-Income Youth

Executive Summary

This flip chart contains various scenarios and barriers that low-income youth with behavioral health conditions might face when trying to access services, and includes suggested steps an advocate could take to work through those barriers.*

Medicaid is the country’s most inclusive health care program, providing high quality, affordable coverage to more than 75 million low-income individuals. Approximately 38% of all children are covered by Medicaid. Medicaid plays an outsized role in funding behavioral health services – it is the single largest payer for mental health and substance use disorder services. In exchange for federal funding, states must meet a number of requirements governing who is eligible, what health care must be provided, and protections for enrollees.

One of these Medicaid requirements is Early and Periodic Screening, Diagnostic and Treatment (EPSDT) – a benefit that entitles low-income children under age twenty-one to a myriad of medically necessary behavioral health services. Because of the EPSDT benefit, children in Medicaid are often entitled to an array of community-based behavioral health interventions that children enrolled in private insurance are not.

*Because Medicaid is a federal-state partnership, there are certain requirements that all states need to meet and other features that are optional for states. Income and other eligibility limits vary among states. We have linked to general resources that can help discern state-specific eligibility limits, but when in doubt, check with a lawyer in your state.

This research was funded by The Annie E. Casey Foundation, Inc., and we thank them for their support; however, the findings and conclusions presented in this report are those of the authors alone, and do not necessarily reflect the opinions of the Foundation.

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