Who pays for mental health insurance? (paranoid, psychiatric, medication, therapy)

[crockpot]

I'm out of work and only have a state medicaid.

I always wonder who pays for one's mental health and medication? How does a patient at a ward pay for their stay?

[Curmudgeon]

Medicaid will usually pay for a certain number of outpatient visits and for some inpatient time when medically necessary as well as prescriptions.

[ImaloneJill]

I work on a mental health unit and do assessments and referrals in the ED. I also do transfers and work with insurances. In the state of Illinois, people who have the medical card and need inpatient treatment usually get transferred to a hospital that is contracted with medicaid-at least for psychiatric and substance abuse issues. The state will pay a certain percentage on the dollar-I am not sure if the patient is ever billed for the remaining amount or the hospital eats the cost as a charitable donation.
The medical card needs to be kept current, send in your paperwork on time. Workers in the ED have access to a computer program that tells us if your eligibility has lapsed and you might end up in a state facility if you need in-patient hospitalization.

[Tracysherm]

Medicaid in every state pays for mental health services. But in some states it may be "carved out" or administered through a Medicaid Waiver program. But it's still all the same federal Medicaid dollars that go to the state, and get combined with the state's Medicaid dollars.

States that still have state hospitals (like NJ) divert a separate funding stream to cover Medicaid people who are inpatient in the state hospital. Then as they transition back to the community, their Medicaid kicks in again.

Some states have a lot of choice among mental health providers for people on Medicaid. When I worked in Philadelphia, it was at the time that Medicaid/ Medical Assistance Managed Care was new. After the initial adjustment of getting used to managed care, the programs and services available to people on Medicaid opened up greatly. The typical person in Philly on medicaid who needs outpatient therapy and med mgmt has their choice of at least 5-10 places they can go to, even more if they want to take a train or bus a tavel a little farther. Also, most inpatient mental health providers in the Phila area accept managed-care medical assistance/ medicaid.

Right over the river in NJ, the typical person on Medicaid might have one outpatient clinic in their whole county that takes Medicaid, and they'll be on a waiting list for months. NJ doesn't have behavioral health managed care, and all the treatment focus is on residential and day programs. Most people just need outpatient, but there's almost nothing. They sometimes end up having to get worse and enter a partial care (day program.)

Medication coverage will be based on a formulary. If you have straight Medicaid, your state should have its drug formulary somewhere on its website. If you have Medicaid managed care plans, each company will have a drug formulary. A formulary is just a list of meds they will cover, along with some meds they will only cover if certain requirements are met.

[crockpot]

Thanks. I do have medicaid up-to-date.

would going to one be a strike on my record or anything like that?

[Tracysherm]

Privacy for all healthcare is regulated by pretty strict rules federally, and most states have even stricter rules. Privacy for mental health records is even more strict.

Unless you fall into one of these categories below, your records of getting mental health services should be secure. (I say "should" because there are always hackers & breaches that can happen).
1. Going for a high level government or military security clearance.
2. You present an imminent danger to yourself or others (the professional you're seeing has to take appropriate action, but that doesn't mean making all your info public, just what info is required to keep you or your target safe).
3. If you get involuntarily committed to a psych hospital (for being a danger to self or others) you will have trouble getting some gun permits, and in purchasing a gun.
4. If you are getting mental health treatment for a work-related stress, cause by the job, and you're getting it paid for by worker's comp, there will be a record with your employer that you got treatment, and a few forms will get filled out by your MH professional, but again, this does not open up all your records.
5. If you are on a psych medication and have a CDL (commercial drivers license) you may have to get drug tested and certain medication will show up, and certain medicaitons will have to be disclosed if they can impair your driving.
6. If you get involved in a lawsuit involving your mental health, or a criminal case involving your mental health, your records can be subpoenaed and/or court-ordered.

But basically, getting an assessment, counseling, and meds is nobody's business but yours, your doctor's/therapist's, and whoever pays (like Medicaid). Medicaid only requires a small amount of info from the provider in order to pay for your services. Mostly your name, DOB, address, account number, and a diagnosis, and a code for what service they gave you. They don't ask for details of what you talked about. Once a year or so, Medicaid will audit your provider and they might ask to see a few charts, and yours might be in that pile. They just want to ensure that the provider is following the rules, and documenting your services accordint to standards. They really don't even get into any detail about what is in the notes, unless there is some suspicion that the provider is doing something fraudulent. So if a Medicaid person looks at your record, she's just checking of if this form is there, and if this form was signed and dated on time. The Medicaid reviewer is also bound by privacy laws.

A lot of people are nervous about going to counseling, afraind there is some "permanent record" that people will later have access to. But there really is not anythng public. And the content of your records is protected by so many laws you could sue under if they ever violated your privacy.

The only thing that does concern me, as a privacy officer and as an American, is the move toward sharing electronic healthcare info among treatment providers all in the same network or "healthcare homes" as outlined in the ACA ("Obamacare"). Again, these plans will still have to be governed by HIPAA and other laws, and you presumably will still have control over who can view your electronic health record, but with these big networks sharing info, I have personal concerns about everyone not following the rules, or hackers breaching the info. I also have concerns that government officials will have access to this electronic info, as more and more healthcare becomes government funded. If government is paying for a person's healthcare, and that person goes for certain government jobs, how much will they pry into the person's health records--I'm thinking highly sensitive info like HIV, substance abuse treatment, and mental health. But people would just call me paranoid for that...

But as things are today, your records should be safe & secure, with the exception I noted above. Wherever you go for treatment, they legally have to give you a Notice of Privacy Practices, and info on who to contact if your have questions or concerns about your privacy.