After the Sandy Hook shooting, the Connecticut legislature called for a report on what should be done to improve mental health care for children in the state. That report came out recently, and it includes a proposal to significantly change the kind of care people with private insurance can get.
Dawn Schneider of Stamford says she knew early on that something was different about her son Curtis from the severity of his tantrums. By the time he was four, Curtis was having ideas about suicide.
“Like he wanted to cut off his head and be dead and chop himself into pieces, throw himself into a fire." Schneider said. "Very graphic, disturbing things that are painful to hear coming out of the mouth of a four-year-old.”
Ten years later, Curtis is doing better, but still faces significant challenges.
“His main diagnosis is bipolar one," said Schneider. "He also has a generalized anxiety disorder. He has Tourrette’s Syndrome. He has various learning disabilities.”
Schneider says with high deductibles and copayments in their private insurance, it was hard to pay for all the hospitalizations, inpatient therapy programs, and seemingly unending visits with specialists.
“So if the psychiatrist is $400, you’re paying 40 percent of that every time you go to the psychiatrist," she said. "Well, when Curtis was really sick, we were going to the psychiatrist every 3 weeks. That’s a lot of money.”
Eventually, they wound up turning to the state for help. When it comes to mental health, there’s an unusual inversion of Connecticut’s economic disparity. Because the state has really invested in providing mental health services for the kids on its Husky Medicaid program, health care providers and parents say kids at the bottom of the economic ladder get more coverage for things like at-home psychiatric care than kids whose parents have private insurance.
Schneider wound up qualifying for a program from the Department of Children and Families to get Curtis covered by the state program. But most families with private insurance don’t manage to do that, and kids can sometimes be left without access to expensive therapies that could help them.
Sherry Perlstein is the President and CEO of the Child Guidance Center of Southern Connecticut. She says paying for the care they provide is a real challenge for privately insured families.
“We set a sliding scale fee for them to make it an affordable service, and then we have to subsidize that fee in order for us to be able to keep our doors open,” said Perlstein.
She says a lot of other providers can’t afford to subsidize the care, so they refuse to take privately insured patients.
In its research for the new report, the state found patients and their families were having a hard time navigating a patchwork system of public agencies and insurance carriers. So they proposed a consolidation - what they call a “care management entity” so people have a single place to go for coordinated care.
“An effective system must be reorganized to include pooled funding across all payers – public and private,” Joette Katz, the commissioner of the Department of Children and Families, told a legislative hearing.
On the public side, Perlstein says state grants they use to keep the lights on at the Child Guidance Center will wind up going into that pool, and she’s worried about losing that security. On the private side, she doesn’t think the insurance companies will go for it.
“What they are saying is that somehow they are going to, and the word they used in the plan, 'incentivize' all of the insurance people to come to the table and throw their money into the pool. That’s a pool I’m not sure I know how many people are going to be willing to swim in.”
Keith Stover is a lobbyist for the Connecticut Association of Health Plans.
“I guess I think insurance companies wouldn’t endorse it because I don’t think there’s any indication in the data that somehow public programs are dramatically superior to programs that are available in the private sector,” said Stover.
Also, Stover says the pooling plan won’t work because half of the people with private insurance get it through their self-insured employers and federal law prevents states from telling those companies what benefits to offer.
Vicki Veltri is the state Health Care Advocate.
“To me, employers also need to be at the table," Vetri said. "Because they’re part of developing plans for their own employees that need to be more responsive to the needs of their employees.”
Veltri says the pool is a long-term goal, that can’t even be created until the legislature takes action on it.
A representative of the state’s Office of Policy and Management says there’s a plan to invite behavioral health providers and insurers to a meeting in November to talk about the pooling idea.
At least one health insurance company in the state has shown it’s open to paying for more behavioral health care for kids.
Brad Witte of Anthem Blue Cross Blue Shield says they’re still reviewing the plan and can’t comment yet on the pooling idea. But last September, Anthem contracted with a mental health services organization called Wheeler Clinic, to become the first commercial carrier in the state to offer intensive in-home behavioral health services for kids.
“We identified there was a need for a program like this for Connecticut’s youth that were covered by commercial insurance,” Witte said.
Witte says Anthem’s now contracting with other providers to expand the service statewide.
“We think it’s the right thing to do," he said. "We also think by reducing unnecessary hospital-based treatment, it will pay for itself.”
And that may be the key. If insurers can actually save money by investing more in children’s mental health services, some state officials hope they can be convinced to dive into that pool.