Health care reform and vulnerable adults with mental health needs

Background: Health Insurance coverage is an important predictor of access to mental health treatment. The Patient Protection and Affordable Care Act of 2010 (ACA) will facilitate access to care by extending health care coverage to millions of uninsured adults. The ACA will also implement the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Act of 2008, providing equitable insurance coverage for substance use and mental health disorders.

Objectives: This study examines the potential impact of health care reform on uninsured adults in California with mental health needs and highlights the characteristics of vulnerable populations who are eligible for mental health services but who do not receive treatment.

Methods: The 2009 California Health Interview Survey is used to identify the number of uninsured adults with mental health needs who will be eligible for the Medi-Cal expansion or the Exchange under the ACA. Demographic and socioeconomic characteristics are examined as well as patterns of mental health service use between the uninsured and insured adults with mental health needs. The adult population ages 18 and older who reported symptoms consistent with severe psychological distress and at least a moderate level of mental health impairment (N=2,365) were studied.

Results: Preliminary findings indicate that approximately one third of all adults with mental health needs were uninsured all or part of the year. More than two-thirds of these adults reported receiving no mental health treatment in the past year, a proportion that was significantly higher than it was for adults with mental health needs who had either public or private insurance coverage all year. Eight out of nine uninsured adults with mental health needs will be eligible for health insurance coverage in 2014. Among insured adults with mental health needs, Latinos, adults who do not speak English well, and physically healthier adults are the least likely to receive mental health treatment.

Conclusions: The findings reveal that the vast majority of uninsured adults with mental health needs will be eligible for the Medi-Cal expansion or the Exchange under the ACA in 2014, but do not currently receive needed mental health services. The findings also highlight a low level of mental health care utilization among insured populations, indicating that health insurance coverage alone is not sufficient in meeting the mental health needs of these vulnerable populations.