ACA Helping with Mental Health, But Texas Coverage Gap Remains

Updated: Our April 18th blog post reported that the American Mental Health Counselors Association (AMHCA) estimated 652,000 Texans with mental health conditions or substance use disorders are in the Coverage Gap. However, AMHCA's analysis is based on an estimate of 2.3 million Texans who could benefit from a broad Medicaid expansion, including legal immigrants and those above the poverty line. A more common definition of the Texas Coverage Gap, however, only includes uninsured Texans below the poverty line who are excluded from low-cost health coverage in the Marketplace, and so would likely benefit from the state accepting federal health care funds to close the Gap. Most estimates place that number closer to one million people. AMHCA’s report did not estimate what portion of the 652,000 uninsured Texans is below the poverty line.  If they make up the same share as estimated for the larger population (28%), then about 293,000 out of the Coverage Gap population of roughly one million would be Texans with mental health conditions or substance abuse disorder. An updated version of the original blog post is below.

The Affordable Care Act’s rollout is nearly complete and many Texans with mental illness and substance use disorders are already reaping the benefits. They are receiving financial assistance to purchase health coverage in the newly created Health Insurance Marketplace, which many people access through All health plans sold in the Marketplace must include mental health and substance use benefits and those benefits must be at parity with health benefits. If they missed their chance to sign up by the March 31 deadline, they can buy Marketplace insurance for 2015 starting on November 15, 2014, or enroll anytime if they lose a job or have a baby.

Unfortunately, many individuals with mental health and substance use disorders still do not have access to health coverage. As highlighted in a recently released report by the American Mental Health Counselors Association (AMHCA), more than a quarter of all individuals eligible for Medicaid expansion or an alternative solution have a mental health condition or substance use disorder.

In fact, of the total number of Texans in this Medicaid expansion population, more than 1 million individuals are left with no affordable options at all. Because they cannot afford health insurance and make too little money to qualify for financial assistance in the Marketplace, these Texans fall into the Coverage Gap.

To fix the Coverage Gap and provide them with insurance, their states must accept new federal Medicaid dollars. Twenty-five states, including Texas, have neglected to do so.

Nearly 8 out of 10 of these uninsured individuals with mental health and substance use conditions who would be eligible for Medicaid expansion or an alternative solution reside in just 11 southern states. The majority of these individuals with serious mental illness are between the ages of 18 and 34.

The research is clear on the benefits of health coverage for those with mental illness and substance use disorders. Uninsured individuals with mental illness often go without needed preventive and routine care that would keep them healthy and thriving in their community. If individuals do not get the treatment needed for their mental illness, they can end up in more expensive crisis and in-patient care. Additionally, those with mental illnesses face a larger risk of co-morbid illnesses such as obesity, diabetes and high blood pressure. Therefore, we need to ensure that those with mental illness have access to a full range of health benefits – benefits that they wouldn’t get in many states’ indigent public mental health systems.

Finally, while the Coverage Gap is made up of low-income working adults, nearly half are also parents. We know when parents have health coverage, their children are better off. In fact, children whose parents live with depression often have higher rates of mental health problems themselves and require more care. By covering parents in the Coverage Gap we have the means to improve the family environment in which children develop.

Texas has made great strides recently to provide more treatment and services to some uninsured individuals with mental illness and substance use disorders. But, as the AMHCA report states, “What better way to dramatically reduce stigma, discrimination and outright rejection… than opening up the Coverage Door to [all] those with mental illness so it is treated like any other illness.”

Closing the Coverage Gap for those with mental illness can be Texas’ next great step forward.

Written by Clayton Travis, Texans Care for Children. Cross-posted from the State of the Children blog.