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Illinois’ trouble with mental health care access

As Illinois faces a significant shortage of psychiatrists, Illinois mental health advocates are warning that the state’s mental health care system hangs in the balance.

Illinois state legislature passed a bill in May designed to make it easier for patients struggling with mental health and addiction to get insurance coverage for treatment. However, there’s still disparity between state laws and federal parity.

Joshua Nathan, the behavioral health director for the National Alliance on Mental Illness of Lake County said while there are great laws in Illinois for parity, the problem rests with the enforcement.

Failing to comply with state law creates problems with access, Nathan said, adding that funding is also a factor.

“Part of the issue could be low Medicaid reimbursement and that the care isn’t available,” he said.

Psychiatrists are getting paid less for their work, and fewer psychiatrists are accepting insurance, Nathan said.

“Even with insurance, most people have to go out of network and pay out of pocket to be seen by anyone in the mental health profession,” Nathan said. 

Recent changes, such as the 1115 waiver granted the state extra funding for mental health services have provided some relief, but the waiver does not include psychiatry.

John Fallon, treasurer of NAMI Lake County said providers are frustrated not just from failing to get reimbursed from managed care companies but also by the consequences that the state had been without a budget for two years.

“A lot of providers were hurt by the absence of a state budget,” Fallon said, “Many of them went a year without payment, particularly in central Illinois, a lot of mental health care providers went out of business.”

Illinois is spending less money on mental health care in comparison to 2016 because many of the mental health care providers who were dependent on those payments are out of business, Fallon said.

The managed care companies were giving the state a loan that it hasn’t been able to pay back, due to the absence of a budget.

“Companies that are carrying the state are owed a lot of money,” Fallon said. “They were paying providers even though the state wasn’t paying the managed care company, because they were required to offer their services.”

The declining number of providers offering social services had led to a 38 percent drop in payments. A big part of the problem is that social services are often overlooked by the state.

“It’s the people that go to community mental health centers who are really struggling, because social services are the last thing that gets funded by the state,” said clinical psychologist Terrence Koller.

One of the problems with insurance was the recipient’s perception of their coverage. According to Koller, many thought they were insured because their employers were buying insurance.

However, the insurance that was purchased was usually low level, catastrophic coverage.

“The minute you would need coverage for something, you would learn one of two things,” Koller said, “you either had to pay a lot out of pocket before insurance kicks in, or that certain things like mental health were not covered by insurance.”

Financial capability is a major determinant in whether or not people seek care, which is what fueled the passing of the Affordable Care Act. But with companies reluctant to pay extra fees for insurance, the restrictions are still in place. The Illinois Psychological Association, for which Koller is the legislative liaison and federal advocacy coordinator, advocates for legislation that protects the rights of psychologists and their patients.

While Fallon and many others like him admit that Illinois has a lot of catching up to do, the fight for mental health care must continue.

“We need to find better training and better pay so that we can keep people in the field longer, and to develop the skills necessary to keep people out of institutions,” Fallon said.

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