Ohio children unable to access mental healthcare because of insurance, costs, and lack of providers

Costs, provider availability, and health insurance limitations were the top reasons Ohio children were not able to access mental healthcare, according to a recent study from the Health Policy Institute of Ohio.

Nearly half said unaccepted health insurance was the reason their child did not receive mental healthcare treatment while 40% said provider availability and 29% said cost (people surveyed could select more than one barrier).

"Many young Ohioans experience mental health challenges, and families often have difficulty navigating the mental healthcare and insurance systems," according to the study.

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"Accessing needed mental health treatment is important, especially for children, because mental health conditions often continue into adulthood."

The average out-of-pocket cost for an individual 60-minute psychotherapy visit with an out-of-network provider cost $55 in 2021, according to the study.

"If a child needs to receive treatment from an out-of-network provider for therapy once a week … the family would pay an average of $220 per month," the study said.

Seeing an in-network provider came with a $28 out-of-pocket price tag, it showed.

That cost jumps to $164 for someone without health insurance or someone who pays without insurance, the study said.

"Healthcare for mental health issues can be expensive, and as many mental health conditions are chronic, they often require ongoing treatment," according to the study. "Costs of care and prescription drugs can accumulate quickly with or without insurance."

OhioGuidestone — Ohio's largest community behavioral health provider that is not a federally qualified health center — charges $142 per hour for therapeutic behavioral services. They charge $206 per day for their day treatment group and $41 per hour for group psychotherapy.

Just under half of Ohio children were on Medicaid and 46% had commercial insurance in 2023.

Health Policy Institute of Ohio found commercial plans rarely cover therapeutic behavioral health support, case management, intensive home-based treatment, behavioral health nursing, crisis services/mobile response, and peer recovery services.

"One of the most important takeaways from this brief is unlike traditional physical health care, it tends to be that insurance problems are more substantial for kids who are on commercial insurance compared to a program like Medicaid," said Health Policy Institute of Ohio Analyst Brian O'Rourke.

"This can range from really narrow provider networks in terms of difficulty finding an in-network behavioral health provider to help with those mental health needs," he said. "It could include really high out-of-pocket costs, even when you do find a provider in network, and then limitations on the types of covered services."

An Ohio patient was 1.6 times more likely to see an out-of-network provider for a behavioral health office visit and 3.6 times more likely to see an out-of-network provider for inpatient behavioral healthcare.

In Ohio, 75 out of 88 counties are mental health shortage areas, according to new study

The state has a lack of mental health providers and 75 Ohio counties are mental health shortage areas, according to a study last year from the Health Policy Institute of Ohio.

Ohio behavioral health clinicians are reimbursed an average of 18% less than medical or surgical clinicians, which can "lead some providers to not accept insurance and instead require patients to self-pay, which is out of reach for many families," according to the study.

Sometimes having a health insurance plan is not always enough.

Going without behavioral health services over time can ultimately make things worse, O'Rourke said.

"If someone's going through with untreated severe anxiety or depression, they're going to have to deal with the burdens of that condition, but also it's going to affect their school performance, potentially their ability to find a job and secure employment," he said.

Ohio lawmakers have introduced a handful of insurance related bills.

Ohio House Bill 219 would create network adequacy standards for Ohio health insurers. Ohio state Rep. Kellie Deeter, R-Norwalk, introduced the bill which has had two hearings so far.

Ohio House Bill 220 prohibits health insurers from retroactively denying a prior authorization for mental health or substance use disorder treatment. Ohio state Rep. Heidi Workman, R-Rootstown, introduced the bill which passed the House earlier this year.

Ohio House Bill 709 would require private insurers to cover telehealth mental health services. Ohio state Reps. Karen Brownlee, D-Symmes Twp., and Meredith Craig, R-Smithville, introduced the bipartisan bill earlier this year and it has had one hearing so far.

The lawmakers are on break and will return after the November election. Any bill that does not pass before the end of the year must be reintroduced in the new General Assembly to be considered.

Health Policy Institute of Ohio recommends the state monitor costs of behavioral healthcare, expand provider availability, and consider changes related to insurance limitations and mental health parity.

Follow Ohio Capital Journal Reporter Megan Henry on X or on Bluesky.

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Courtesy of Ohio Capital Journal