Private Insurance, Medicaid, and Youth Mental Health

New Study Finds Comprehensive Youth Mental Health Services Cost Prohibitive Under Employer Health Plans

Report commissioned by Speak Our Minds reveals Medicaid buy-in option shows promise

Download and access the full report:  FULL REPORT

DENVER, Oct. 8, 2024 — A new report commissioned by Speak Our Minds, a non-profit organization focused on creating a comprehensive system for youth mental health care, was conducted by Colorado Health Institute and found employer health insurance plans do not provide comprehensive youth mental health services, and doing so would be cost prohibitive. The study further concluded that a Medicaid buy-in option for employer healthcare plans could result in better and more affordable access to youth mental health care.

In a 2023 study, 22.3% of Coloradans aged 5 to 25 reported poor mental health and 18.6% of young people said they needed mental health care but didn’t get it in the past year – both of those metrics have increased threefold over the past decade.

The regulatory structure and financial incentives of private insurance mean that benefits critical to addressing the youth mental health crisis – including prevention, screening and early diagnosis – are not covered. Adding these services to employer health insurance plans would cause the costs to skyrocket and become untenable for businesses.

“We are in the midst of a youth mental health crisis and this research shows commercial health insurance coverage is not up to the task,” said Heidi Baskfield, executive director of Speak Our Minds. “As we search for solutions that will provide youth with the services they need while keeping insurance plans financially viable for employers, a Medicaid buy-in option for youth behavioral health services as part of employer health plans must be considered seriously.”

Medicaid’s behavioral health services for children and adolescents are part of the program’s overall benefit package, known as Early and Periodic Screening, Diagnostic and Treatment (EPSDT). EPSDT includes a robust set of benefits and aims to ensure children receive early detection and care to treat health problems through regular health and developmental screenings.

Screening options are more limited for children with private insurance coverage. Private insurance tends to focus on higher acuity care, the type of care specialists and doctors can bill for. In theory, Medicaid offers a richer set of behavioral health benefits.

A potential Medicaid buy-in would allow private insurance customers and others who are not eligible for traditional Medicaid to purchase a full spectrum of behavioral health services for children and youth from their state’s Medicaid program, rather than getting that coverage through their private health insurer. Private insurance would continue to cover all other services.

The concept of a Medicaid buy-in for youth mental health services is garnering bipartisan support in the Colorado state assembly, with Colorado state Senators Barbara Kirkmeyer (R) and Dafna Michaelson Jenet (D) motivated to take action that could include legislation this session.

“I can’t think of an issue more important and pressing than youth mental health,” said Senator Michaelson Jenet. “It is our duty to ensure Colorado’s children and youth have equal access to the services they need to thrive, and a Medicaid buy-in just makes sense.”

“A Medicaid buy-in would not only increase access to youth behavioral health services but it would also lower costs for Coloradans,” added Senator Kirkmeyer. “I look forward to working with my colleagues to explore a path to making this a reality.”

In a 2023 national survey, 77% of employers reported increased mental health issues such as depression, anxiety and substance use disorder, among their workers and their dependents. Businesses offer health insurance as a perk and they want to ensure their employees can access the services they and their families need. A Medicaid buy-in option for youth mental health services could mean significant cost savings for employer plans.

“As an employer, we want our team and their families to feel cared for through the health insurance plans we offer – it’s just good business,” said Trudy Fountain-James, Chief Legal Officer, ATOS North America. ”We want to be part of the solution to the youth mental health crisis but, unfortunately, any private insurance plan that would include all the services needed to address those challenges would be an unsustainable hit to the bottom line. The idea that we could offer an alternative such as a Medicaid buy-in gives me hope.”

About Speak Our Minds

Speak Our Minds is a 501(c)(3) nonprofit dedicated to building a comprehensive system of youth mental health care. It is the only organization that focuses entirely on creating an effective system of care to address the youth mental health crisis. Speak Our Minds brings together providers, payors, parents, experts, elected officials and business entities to champion accessible mental health care. Speak Our Minds connects the dots to create life-saving change for America’s youth. Learn more at www.speakourminds.org.