How Low-income Ohioans Can Overcome Financial Barriers to Mental Health Treatment

Jun 19, 2018

One of the barriers to finding the right mental health care in Ohio can be the cost. However, there are providers who offer services at little or no cost to low-income clients. In this installment of our series "Navigating the Path to Mental Health," WKSU’s Mark Arehart looks at the financial challenges facing both patients and providers.

Mental health services in Ohio can be expensive. Health insurance can ease that burden, but according to the Ohio Department of Insurance, premiums for individual plans cost $5,798.83 on average.

Many low-income Ohioans like Curtis Harbour just can’t afford that.

"This is my Max, my service dog. He’s a standard Schnauzer and he’s my best little friend," Harbour says as he rubs his dog's belly at Portage Path Behavioral Health in Akron. 

Harour comes to Portage Path for treatment for depression and post-traumatic stress. It's a place where he feels safe. 

"The doctor I have now, when it comes to my medicine, he listens to me. And because of my past with certain medicines, I don’t want to take them. Like Seroquel; I tried to commit suicide on. And I don’t want that feeling again."

He’s just one of tens of thousands across the state who receive financial help to get the mental-health care they need.

Helping Those in Need
"Our clients really don’t have money to do much of anything," says Sean Blake, vice president of outpatient clinical services at Portage Path. 

That's where safety-net programs step in, Blake said, to give providers like his the financial backing to offer treatment to those who may not be able to afford it.

Portage Path Behavioral Health in Akron is one of many low-income mental healthcare providers statewide.
Credit Mark Arehart / WKSU

The lion’s share of the funding comes from Medicaid. The rest comes from county mental health and addiction services funders, usually called ADM or ADAHM boards.

Since expanding its Medicaid program in 2014, Ohio now accepts more federal money to help low-income residents. This frees up the county boards to be more flexible with their funding.

Blake says this allows providers like like Portage Path to "redirect some of our ADM dollars toward more indigent care. So we were able to serve more people who were uninsured in the county."

But the keyword here is county. Summit’s ADM Board is largely funded through a local property tax levy.

"We feel very supported by our ADM Board. And we work really hard with providers, our other providers in the community to provide the best care possible. So that’s how we’re rich here in Summit County," Blake says.

Financial Barriers for Providers Differ County by County

It's a different picture just to the west in Medina County. 

"Primarily our funding is dependent on state and federal dollars," says Phillip Titterington, executive director of Medina County ADAHM Board

Titterington says any shift in federal or state funding swiftly impacts Medina.

County boards statewide provide supplemental funding to low-income mental healthcare providers.
Credit The Association of County Behavioral Health Authorities

"This county does not have a social service levy or an ADAHM levy."

Some county boards in Ohio have tax levies and others do not. Many counties have had to band together to pool resources.

It's a complex system that is getting even more complicated.  The entire structure for how providers get paid for services is changing drastically in what's called Behavioral Health Redesign.

Rewriting the Rules
"Behavioral Health Redesign has two phases to it," says Lori Criss, CEO of The Ohio Council for Behavioral Health and Family Services Providers. The Ohio Council is a trade and advocacy group representing nearly 150 meantal healthcare providers statewide. 

The first phase of the redesign started Jan. 1, when Medicaid expanded the number of billing codes from 17 to 120.

"This is inside baseball, kind of backroom business functions. But it really should be invisible to the patient," Criss says. 

But she says the more complex system has been difficult to navigate for some providers. 

'Many of our providers have talked about this as working on a car while it's going down the highway at 90 miles an hour.'

Tracy Plouck, director of the Ohio Department of Mental Health and Addiction Services, says the changes allow for more precise billing. 

"The payment system became more granular. Which had the ability, No. 1, for Medicaid to see more clearly what they were actually buying with public dollars. But it also gave providers more ability to seek reimbursement for the specific services that they were rendering." 

She cites recent data that suggests providers are starting to get a handle on the new billing system. 

More Changes on the Horizon
The second phase of Behavioral Health Redesign, dubbed  Medicaid Managed Care starts July 1.

It changes how providers are reimbursed, going from Medicaid acting as one big insurer for all mental-health services to contracting with five separate insurance companies.

This mirrors the way Medicaid recipients already get coverage for their physical care.

"So instead of just focusing on the primary (physical) care side of things, they’ll  actually be looking at the whole person. Which I think we would all advocate for," says Jerry Craig, executive director of the Summit County ADM Board. 

A Mental Health America survey found 49 percent of those polled only sought primary care, compared to 14 percent who sought both primary and mental healthcare.
Credit Mental Health America

But he has some big concerns about this redesign as a whole. Like Criss with mental-health-providers council, he says it’s been a struggle for some providers who have had to learn how to get claims filed properly. 

There have been longer wait times to get reimbursed, which could be a huge problem for some providers who only have a month or two’s cash on hand.

"Many of our providers have talked about this as working on a car while it’s going down the highway at 90 miles an hour,” Craig says. 

Plouck says having the same insurers cover Medicaid recipients in both their physical and mental health care streamlines the system and opens the doors for many low-income Ohioans who may not know where to turn. 

"There are many people in Ohio who are receiving physical healthcare through Medicaid who are completely disconnected from behavioral-health care providers because maybe they don’t know about them, they don’t know they have access to see a provider through the Medicaid benefit."

Getting to a Better Place
All these stakeholders agree that ultimately it’s about bridging the financial gap to mental health care for low-income Ohioans.

Back at Portage Path in Akron, Curtis Harbour's service dog, Max, is still enjoying his belly rubs. Harbour has improved his living situation, gotten married and has even found a passion for dog grooming.

"Every day for me is another therapy session. Instead of my therapist once a month or twice a month, the dogs are my therapy for everyday."

He said he feels his life is more stable now that he’s found the care he needs.

The WKSU series: “Navigating the Path to Mental Health"

Part I (May 29): Achieving Acceptance: Overcoming Stigma on the Path to Mental Health. One out of five Americans, this year, will experience a mental health disorder. Yet, for all its prevalence, many people dealing with mental health crises still face stigma and shame.

Part II (June 5):Mental-health care can be hard to access in much of Ohio, especially away from the larger cities. This installment looks at the challenges along the way to finding and getting mental-health services.

Part III (June 12): Mental-health treatment evolves through meds, mindfulness and motivational interviewing.

Part IV (June 19): Mental-health treatment can be expensive, and the financial incentives may be a barrier, rather than incentive. 

Part V (June 26): Police and the courts are increasingly on the front-line of mental-health care, and are getting better training to do it. 

Part VI (July 3): Pink-slipped, a personal story

Join us June 27 for a community forum on mental health at the Akron-Summit County Public Library  at 7 p.m.