COVID-19 was a program that mandated the termination of Section 1915 (E) and (F) plans for all hospitals with more than 100 beds." Maintaining Section 1915(e) & (f) plans can be a difficult process as it requires constant oversight. This requirement had been in place since 1996 when Congress passed the Health Insurance Portability and Accountability Act of 1996. In 2012, President Obama signed into law the Affordable Care Act which mandates that all health insurance policies must provide coverage for certain medical care, including substance use disorder treatment. The ACA is responsible for COVID-19's mandate on hospital termination of ED and E/F plans.
On February 8, 2015, Ascension Health announced the termination of its E/F plan. Ascension Health was a non-profit health system in Missouri that included 22 hospitals and numerous clinics and physician practices. They had previously agreed to purchase Celerity Health which also included providers in the St. Louis Area. The discussions started before COVID-19 was implemented, but still caused some controversy due to the potential for a monopoly of health care services in the area. This change left Kedren Community Health Center with only four hospital partners that have E/F plans - Mercy, SSM Cardinal Glennon Children's Medical Center, SSM St. Mary's Hospital, & SSM St.
What is included in a COVID-19 plan?
The insurance provider must cover a wide range of services including mental health and substance abuse counseling (covered at 100%) & medical care for mental health/substance use conditions (covered at 100%). They would also cover maternity care (100%), as well as "other medically necessary" services – but the word "medically necessary" is very broad.
What are the benefits of a COVID-19 plan?
KCHC does not provide services directly, but if one of our providers refers an insured client to a mental health/substance-use disorder professional outside of KCHC, that provider will have some assurance that their patient is getting appropriate care. This is true for any health care provider in the region, and not just KCHC.
Can I still see a mental health/substance-use disorder provider at KCHC?
Yes, if the patient already has an insurance plan that covers mental health/substance use treatment. The patient will also have to pay out of pocket for the shares not covered by their insurance. This can be very expensive, so it is important that clients are aware of this before they seek treatment. Although many clients have a mental illness, few will have the resources to pay out of pocket for visits to a therapist or psychiatrist.
If a patient has an insurance plan that covers mental health/substance use, can they still come to the KCHC Health Center?
Yes, if the patient needs services that aren't covered by the insurance plan. This could be for STIs and pregnancy screenings, for example. However, before receiving care at KCHC, our patients must contact their provider to obtain a referral for care at KEDREN Community Health Center. The referral process has changed since COVID-19 was implemented in 2012.
If a patient does not have insurance, can they still come to the KCHC Health Center?
Yes. Even though mental health and substance use treatment are no longer covered under the E/F plans at Mercy, SSM Cardinal Glennon Children's Medical Center. SSM St. Mary's Hospital, & SSM St. Joseph Health Center, our patients will still get the care that is not covered by their insurance plan (for example pregnancy tests). They will be responsible for any share of the cost not covered by their insurance plan or Medicaid.
Conclusion
Treatment of mental illness and substance abuse will be more accessible to everyone living in the St. Louis area. This is a step in the right direction in addressing mental health and substance use issues that impact communities all around the world. Yet, it has gone more than ten years without federal funding to meet the needs of each individual with mental illness, throughout the nation. "The ACA is only a piece of change that can work towards treating those who suffer from mental illness," says Joanna Landers, a clinical therapist for KCHC for over twenty years and director of outreach for Behavioral Health Services at KCHC since 2011.
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