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There is an imbalance between public and private mental health services, said experts at the legislature’s mental health services working group on Tuesday.
“The services we are able to provide are different than services people can avail themselves of when they have private insurance,” said Patricia Rehmer, commissioner of the Department of Mental Health and Addiction Services.
Mental health topics that state legislators will discuss during the first half of their working group meeting include public mental health services versus private services and mental health services available through the court system.
The mental health department primarily serves individuals ages 18 and above who are underinsured or uninsured, Rehmer said. The department provides numerous services to 100,000 people with mental health and substance abuse disorders annually.
One program the department hopes to increase is the recovery-based Assertive Community Treatment, which provides peer support, supportive housing and rehabilitation, she said.
Rehmer said Medicaid has co-pays only for medication, not for treatment, with no limitations on outpatient visits or case management services through public mental health services.
“The bigger gaps are for individuals with private insurance,” Rehmer said.
For example, in the private sector a person who needs “acute inpatient treatment” is limited to five to seven days in a hospital, she said.
There are also people who have insurance but choose to pay out-of-pocket to keep their loved ones’ diagnoses from going on a medical record and, consequently, get even less financial support for treatment, Rehmer said.
If the stigma surrounding mental illness isn’t addressed, “we will have a very hard time increasing their access to services or at least to utilize whatever means they have to pay for these services,” she said.
Vicki Veltri, with the independent watchdog agency, the Office of Healthcare Advocate, said the agency is mostly hearing complaints from people with private insurance.
One in five people has symptoms of mental illness and one in 20 suffers from severe mental illness, she said. But not everyone is receiving treatment, to which there are many barriers, she said.
For example, “if you have private insurance, you are not going to get many of the community-based programs,” Veltri said.
In Connecticut, private health insurance companies also decide the criteria, based on medical association’s recommendations, for which services to cover. But the healthcare advocate office has found that health insurers' criteria for which services are considered "needed" vary widely.
Veltri also said that Connecticut’s health insurance plans are different from neighboring states’ plans. In other states if a patient has a neurological issue, a neurologist would decide which services are needed, she said. But in Connecticut, someone else -- without matching expertise -- could make the decision on which services should be provided for that person, she said.
If someone is paying a premium every week, they should get access to services according to his or her provider’s recommendation, she said.