Jul 11, 2019 in Medicine

Health Insurance: Mental Health Care Services

It is estimated that about 5.4% (232,932) of adults and 11% (106,149) of children in Wisconsin have a serious mental illness. Out of these, an estimated 90,000 Wisconsin children and adults with severe mental illness use Medicaid services, which cover 28% of mental health services for persons served in the public mental health system. These statistics necessitate that an insurance policy be critically studied for its ultimate effectiveness in meeting the needs of mental health care, both in terms of counseling services and medications offered.

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Forms of mental health care covered under Medicaid in Wisconsin

There are two types of services covered by Medicaid; mandatory and optional ones. The Mandatory State Plan services are inclusive of in-patient psychiatric care, outpatient psychiatric care, physician services and early periodic screening, diagnosis and treatment mental health services. The Optional State Plan services includes other licensed practitioners offering psychiatric and psychological services, clinic services, many packages for rehabilitative services, and targeted case management services. All these plans have varied coverage requirements.

Level of counseling in the cover

The mandatory plan covers in-patient psychiatric services for individuals under the age of 21 (in-patient services are not available for those between 22-65 years). Outpatient psychiatry services are however available and must be performed within a licensed outpatient facility. A Medicaid certified physician may offer psychotherapy services to patients. Children under 21 years enjoy early screening, diagnosis and treatment mental health services which, however, must be with prior authorization by the Medicaid agency. The Medicaid optional services on the other hand contain wide and varied psychiatric and rehabilitative services (Mental Health and Substance Abuse Services in Medicaid and SCHIP in Wisconsin, 2003).

Coverage of mood altering medications

The plan is not required to cover all drugs needed by a beneficiary. However, the formularly (list of drugs covered) must include all antipsychotic, antidepressant and anticonvulsive drugs required to keep a patient mentally healthy. Through Medicaid, some drugs not covered by Medicare are available, for example barbiturates and benzodiazepines. If a prescribed drug is absent from the list, an individual can ask for an exception while clearly stating why that particular drug is needed.

As much as the Medicaid program is designed to balance out counseling and medication provision for optimal effectiveness, certain scenarios may occur. The main issue of concern though is the case where a beneficiary may fail get effective counseling services but receive proper medication. This is especially true in the case of a person aged 22-65 years and in need of inpatient facilities. This age group is not covered for inpatient psychiatry hospital services, and as a result they may end up getting sufficient medication without receiving adequate counseling.

The probable reason for the discrepancy between counseling and medication in mental health care services is the fact that counseling would address the root cause of the mental health problems and as a result reduce the sales of drugs thus slashing the profits of powerful pharmaceutical companies. Huge budgets are put in place to develop mood altering drugs and novel drug delivery systems to the brain, and massive profits are expected to be accrued after their development. Hence, focus is not placed on psychiatry, psychology and rehabilitative efforts that would be most beneficial to the patients. It appears that most policy makers have vested interests specifically bent towards drug companies in the issue of mental health care.


Current statistics show that many people are in need of mental health care plans in Wisconsin. Medicaid steps in to provide the lion’s share of these services, covering about 28% of individuals in need. The services offered by Medicaid are categorized into either mandatory or optional and range from inpatient services, outpatient care, and counseling services (psychiatry and rehabilitation). Most of the mood altering drugs required by patients are available through Medicare. However, it is observed that beneficiaries may receive medication without sufficient counseling. The main reason behind this is probably the fact that mental health care policies are focused on issuing drugs, which benefits powerful pharmaceutical companies as opposed to counseling.

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