In 2007, 51 percent of Texas children under 18 had private health insurance. But some insurance plans don't cover mental health services at all; others may limit services and set a higher co-payment than for physical health. In Texas, some insurers aren't allowed to limit services for serious mental illness such as schizophrenia and depression.
The 2008 federal Mental Health Parity and Addiction Equity Act will partially address this inequity by requiring employers with 50 or more employees to cover physical and mental illnesses at the same level, beginning in January 2010.
Children's Health Insurance Program (CHIP)
The Children's Health Insurance Program (CHIP) is a public insurance program for families who earn less than 200 percent of the federal poverty level, about $44,000 per year for a family of four. In 2008, about 389,000 Texas children were enrolled in CHIP on an average monthly basis.
CHIP covers mental health and substance use treatment. In fiscal year 2004 more than 43,000 children, about 14 percent of the average monthly CHIP enrollees, used a mental health service through CHIP.
In 2007, 27 percent of Texas children were enrolled in Medicaid, a public insurance program for children in low-income families. Of the 2.85 million Texas children enrolled in Medicaid in fiscal year 2004, more than 267,000 or 9.4 percent, used a mental health service.
Public Mental Health Services
Children who don't have insurance may seek services through state or local public or nonprofit agencies. However, Texas ranks 47th among the states in per capita expenditures for public mental health and the needs far outweigh availability of services.
In 2007, 22 percent of Texas children were uninsured – the highest state percentage of uninsured children in the U.S.
The Texas Department of State Health Services operates the public mental health system, which acts as a safety net for uninsured children. However, uninsured children are not entitled to mental health treatment by law so services are available as funding permits.
The department contracts with regional mental health authorities and a managed behavioral health organization to deliver services statewide. In 2008, a monthly average of 11,126 children were served through the public mental health system.
Youth Empowerment Services (YES)
Some children and youth in Texas simply don't have access to services through insurance, Medicaid or the public mental health system. Faced with this dilemma, some parents relinquish legal custody of their child to the state to access federal funding for intensive treatment. The Congressional Government Accounting Office reports that many children and youth are turned over to the child welfare or juvenile justice systems for this reason. Texas was granted a Medicaid waiver to provide intensive community-based treatment and supports to children and youth with severe emotional disorders who are not otherwise eligible for Medicaid. Parents of children enrolled in the new Youth Empowerment Services will not have to give up custody of their children to obtain services. The program roll out in Dallas and San Antonio was scheduled for late 2009.