Strengthening Insurance Laws Improves Children’s Access to Mental Health Care

A recent UC San Francisco-led study reveals that stronger state insurance laws significantly enhance children’s access to mental and behavioral health services. The study, which analyzed data from nearly 30,000 U.S. caregivers, found that from 2016 to 2019, 1 in 8 caregivers struggled to obtain mental health care for their children. However, those living in states with comprehensive mental health coverage laws were about 20% less likely to report such difficulties compared to those in states with less robust protections.

The study also highlighted disparities among different groups. Caregivers of Black and Asian children, as well as those whose children had experienced more adverse childhood events (ACEs), were more likely to report challenges in accessing mental health care.

“Unfortunately, in my practice, I often see children whose mental health needs go unmet until they reach a crisis point,” said Dr. Ashley Foster, a pediatric emergency care physician at UCSF Benioff Children’s Hospital San Francisco and the study’s lead author. “This prompted me to investigate whether stronger insurance laws could make a difference, and our findings confirm that they do.”

Published on August 12 in *JAMA Network Open*, the study emphasizes the need for not only enacting but also enforcing these laws. Dr. Foster pointed out that even when families have insurance, barriers such as providers refusing to accept certain types of insurance or high out-of-pocket costs can still hinder access to care.

To address these issues, the authors recommend that states invest in community-based mental health services, develop a culturally diverse workforce, and support tele-mental health care. Additionally, states should clearly define the disorders that insurance must cover, such as autism and ADHD, to ensure comprehensive care for all children.

The study’s findings underscore the critical role that state legislation plays in bridging the gap between mental health needs and access to care. In states with stringent insurance laws, children are not only more likely to receive timely mental health services, but the quality and consistency of care also tend to be higher. This is particularly important for conditions like autism, ADHD, and other developmental disorders that require ongoing, specialized treatment. Without robust legal protections, children in need may face significant delays in diagnosis and treatment, potentially leading to long-term negative impacts on their mental health and overall development.

One of the most concerning aspects highlighted by the study is the racial and socio-economic disparities in access to mental health services. Caregivers of Black and Asian children, along with those from lower-income households, reported significantly more challenges in securing necessary care. This disparity points to systemic issues within both the healthcare and insurance industries, where minority and economically disadvantaged families often face additional hurdles. Strengthening insurance laws, therefore, becomes a crucial step not just in improving access for all children but also in addressing these deep-rooted inequalities.

The study also suggests that comprehensive insurance laws alone are not enough; effective enforcement is equally crucial. In many cases, even with strong legal protections in place, families struggle to navigate the complexities of insurance coverage, often facing high out-of-pocket costs or outright refusals from providers to accept certain insurance plans. The authors argue that states must not only pass these laws but also actively monitor and enforce them, ensuring that insurers comply fully and that families receive the coverage to which they are entitled. This includes reducing bureaucratic barriers and ensuring that mental health services are as accessible and affordable as possible.

Finally, the authors emphasize the need for states to adopt a holistic approach to improving mental health care access. Beyond legislation, there is a pressing need for investment in community-based services and the development of a diverse mental health workforce that can cater to the cultural and linguistic needs of the population. Additionally, embracing and expanding tele-mental health services can play a significant role in reaching underserved areas and populations. By taking these steps, states can ensure that all children, regardless of their background or where they live, have access to the mental health care they need to thrive.