The District of Columbia ranks first in the nation for having the lowest rates of youth mental illness and highest rates of access to mental health services for young people; however, these statistics don’t tell the whole story. When examined by neighborhood, data show that youth mental health needs are disproportionately high in Wards 1, 6, 7 and 8, which are predominately communities of color. Additionally, 2019 data self-reported by youth in the District reveal that mental health concerns were disproportionately high among middle and high schoolers of color and particularly among LGBTQIA+ youth of color. Research shows that the cost of mental health services remains a persistent barrier for families, especially for families of color.
Post-pandemic, the U.S. Surgeon General declared a mental health crisis and urged all local, state, and federal stakeholders to increase access to care for youth. In response, D.C. has taken the lead in addressing this issue through policy reforms to decrease out-of-pocket costs for District youth and their families. In 2021, the DC Health Benefit Exchange Authority (DCHBX), which operates DC Health Link (the Affordable Care Act health insurance marketplace in D.C.), convened a Social Justice and Health Disparities Working Group to find a way to address inequities and health outcome disparities in the District. The working group found that youth or their parents were paying up to $45 per mental health visits and as high as $25 in copays per prescription. As therapy visits are often needed several times a month, these costs quickly add up and make receiving regular care extremely expensive for families—many of whom are already struggling with the area’s increasingly high cost of living, gentrification, and other economic pressures.
In collaboration with Whitman-Walker and Children’s National Hospital, DCHBX implemented an equity-based benefit design into their DC Health Link Standard Plans, which are designed to make shopping easier and cover essential in-network services without having to meet the deductible first. Each health insurance carrier in DC Health Link offers a standard plan at various levels of coverage in the individual and family marketplace and the small business marketplace. This policy change resulted in a $5 copay across all Standard Plans for unlimited mental and behavioral health visits and prescriptions for all youth under age 19, with no deductibles. This change means that families that were previously paying $2,340 per year for weekly therapy visits would now pay $260 annually for critical care that their child needs.
While this policy reform positively impacts all youth insured in DC Health Link Standard Plans, it particularly benefits BIPOC and LGBTQIA+ youth for whom the mental health crisis is exacerbated by structural factors such as racism, homophobia, transphobia, and poverty. As Dr. Kevin Waldorf-Cruz, LICSW, Director of Behavioral Health at Whitman-Walker Health, stated, “Queer youth of color in DC continue to face significant issues accessing mental health support in DC. Whether it’s systemic or clinical…it is critical that youth in D.C. have easy and affordable access to mental health care without the extra barriers of stigma, fear, or financial limitation.”
The positive impact of this $5 policy change on youth of color and LGBTQIA+ youth in the District cannot be overstated. It has literally saved lives. And while May is Mental Health Awareness Month, the work supporting the mental health and wellbeing of children is an everyday, all-year effort. In this age of youth mental health crisis, it is essential that all states, employers, and insurers implement innovative policy reforms that provide low or no-cost care for young people and their families, particularly for marginalized youth. This undertaking by the District of Columbia underscores that policy advocates, health exchanges and insurance carriers can and must collaborate as the agents of change to address health inequities and structural racism in their communities. We owe this to young people across the country.
Signed,
Lienna Feleke-Eshete, Senior Manager of Policy, Whitman-Walker Institute
