The Second Revolution for Mental Health Care for Children on Commerical Insurances

Two years ago, state legislators passed historical legislation reforming mental healthcare for children on Mass Health as dictated by the Rosie D vs. Romney case.

Currently, children and adolescents whose behaviors are assessed for severe emotional disturbances (SED) are eligible for the "bells and whistles" of receiving intensive services (therapeutic mentoring; parent support; and in-home behavioral therapies) at home by mental health providers who are Mass Health providers.

In order for them to receive this assessment, their behaviors are prescreened through a paper and pen tool called the Children and Adolescent Needs Scale (CANS), knowns as the CANS instrument. The CANS is simply a guide used by several providers who are trained and certified to use this instrument to be on the same page in assessing the child/adolescent behaviors under the categories for serious emotional disturbances.

While these changes are positive are for children on Mass Health, their counterparts who have commercial health insurances are following through the cracks if their behaviors fall under the SED category. When these children and adolescents are hospitalized for their mental health issues , they are discharged only with in-home therapy services because commercial insurances do not pay for the above mentioned services.

However, there is a loop hole in the system that allows these children and teens to receive intensive services. If a child is placed in the Department of Children and Family custody for substantiated allegation of neglect or abuse, they automatically get Mass Health which subsequently, allows them to receive intensive services. Also, if an adolescent has a CHINS (Child In Need of Services) by their parent; school; or for whatever circumstance, they automatically get Mass Health as a secondary payor under their commercial insurance which is still their primary payor. Furthermore, these individuals are now eligible to receive intensive services.

As you see children and adolescents with mental health issues are being blantantly discriminated against due to their commercial insurances not paying for their intensive services at home. Legislation on the state level needs to be passed to make these commerical insurance companies pay their fair share of intensive services for these individuals. It is not fair for the taxpayors to bring up the tab for their obvious discriminatory practices against children and adolescents who are assessed with serious emotional disturbances.

I call upon all the parents who are frustrated with being ineligible for intensive services for their children to speak out and file a case action lawsuit against the state of Massachusetts. It is time to stop having your children with mental health needs fall between the cracks simply because they have commercial insurances.