Private and Public Health Insurance Coverage for Children

Access to health care services, including mental health services, is highly  correlated to having health insurance coverage. While children enrolled in private insurance plans often face  limitations in their mental health coverage, such as the exclusion of certain  diagnoses from coverage or limits on the number of covered visits for  outpatient therapy, children in Medicaid and SCHIP programs generally  have coverage for a wide range of mental health services. Despite the availability of public insurance coverage, other  factors, such as low Medicaid reimbursement rates that discourage  provider participation or SCHIP cost-sharing requirements that may make  services unaffordable for some families, could affect children’s access to  services. However, many of these  plans impose more restrictive limits, such as day or visit limits, on mental  health benefits than on other benefits. Federal Programs Can Help Children Who Have Experienced Trauma to Obtain Mental Health Services, But Extent of Assistance Is Largely Unknown and Little Evaluation Has Occurred

Beyond insurance, a range of federal programs–-including over 50 grant  programs we identified–-can help children who have experienced trauma  obtain needed mental health services. Some federal programs have a broader focus, such as  general mental health, or are targeted to specific populations, such as  children in foster care, but grantees can elect to use program funds to  provide mental health and other needed services to children who have  experienced trauma and their families.
What GAO Found

Eighty-eight percent of children nationwide have private or public health insurance that, to varying degrees, covers mental health services, including those that may be needed to help children recover from traumatic events, such as natural disasters, school shootings, or family violence. Despite the widespread prevalence of health insurance coverage for children, depending on their type of insurance coverage and where they live, children may face certain limitations in coverage or other barriers that could affect their access to needed services. The 16 percent of children who are enrolled in Medicaid and the State Children's Health Insurance Program public insurance programs generally have coverage for a wide range of mental health benefits, and those enrolled in Medicaid are not subject to day or visit restrictions. Beyond providing insurance that can give children access to mental health services, a range of federal programs can help children who have experienced trauma obtain needed services. GAO identified over 50 programs that can be used by grantees to provide mental health and other needed services to children who have never experienced trauma, although many of these programs have a broader focus and were not designed specifically for this purpose.