Behavioral Health Disparities

12/20/2017

Behavioral health disparities refer to differences in outcomes and access to services related to mental health and substance misuse which are experienced by groups based on their social, ethnic, and economic status.

Behavioral health disparities can be found in the U.S. based on age, sex, income, disability status, sexual orientation, language, geographic location and other factors. Each year, behavioral health disparities lead to significant human and financial costs as racial and ethnic minorities experience worse health status and treatment outcomes, and more difficulty accessing services than their peers in other population groups.

Black adults experience higher levels of behavioral health disorders than members of the adult white population, according to Mental Health America. However, Hispanic and immigrant groups tend to experience lower levels of behavioral health disorders than the adult white population. Lifetime prevalence rates among Latino Americans born in the U.S. are lower than those for non-Latino whites, vary among ethnic groups, and are higher among U.S.-born Latinos than they are among foreign-born Latinos. While there are variable differences in behavioral health outcomes for different ethnic and minority groups, there is consistency in the lack of equitable access to care. State legislators have pursued various policy approaches to reducing behavioral health disparities, and these state innovations are highlighted below.

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Health Disparities Legislation 2017
STATE BILL | SUMMARY | STATUS

Arizona

  • SCM 1012 This resolution urges Congress and the President of the United States to keep and protect the Indian Health Care Improvement Act (IHCIA). The IHCIA provides the foundational authority for the Indian Health Service to be reimbursed by Medicare, Medicaid and third-party insurers; to make grants to Indian tribes and tribal organizations; and to run programs designed to address specific, critical health concerns for Native Americans such as substance abuse, diabetes and suicide. Failed - Adjourned

California

 

  • AB 470 Requires the Department of Health Care Services to create a performance outcome dashboard for specialty mental health services provided to eligible Medi-Cal beneficiaries. Requires the department to convene a stakeholder advisory committee comprised of special representatives to help create a plan for such dashboard. Requires the department to post updated reports on its website. Outlines objectives of the performance outcome dashboard, including eliminating or reducing mental health disparities and strategies for addressing the social determinants of mental health, and includes mental health disparities data in the dashboard. Requires the department to consult with the stakeholder advisory committee and make recommendations for improving mental health disparities. Enacted
  • AB 683 Authorizes several counties to implement a pilot program to provide reentry services and support to persons who are, or who are scheduled to be released from a county jail. Requires the pilot program include specific components including services to address mental health issues, including mental health issues relating to sexual exploitation, racial and ethnic disparities, and trauma, as well as ensuring the program is culturally competent in order to increase opportunities for family friendly contact during and after imprisonment. Enacted

  • AB 850 Requires the governor to appoint an additional member to the Mental Health Services Oversight and Accountability Commission who has knowledge and experience in reducing mental health disparities, especially for racial and ethnic communities. Failed- Vetoed by Governor

  • AB 1188 Adds licensed professional clinical counselors and interns to those licensed mental health services providers who are eligible for grants to reimburse educational loans for working in medically underserved areas. Enacted 

  • AB 1384 Requires California Victim Compensations Board to enter into an interagency agreement to establish a State Pilot Trauma Recovery Center as the technical assistance provider to the board. Authorizes the board to provide grants to the technical assistance provider and gives preferential treatment to providers that serve the chronically homeless, chronically mentally ill, people of diverse ethnicity, members of immigrant and refugee groups, the disabled, and those who have severe trauma-related symptoms or complex psychological issues. Enacted

  • AB 1688 Renames the Mental Health Planning Council as the Behavioral Health Planning Council and revises requirements and duties. Requires that the council members include adults with serious mental illness, persons who are dually diagnosed with serious mental illness and substance use disorder and family members. Requires that the members of the council should be a balance of demography, geography, gender and ethnicity. Enacted

  • ACR 86 Recognizes May 10, 2017, and each May 10 thereafter, as Asian and Pacific Islander American Mental Health Day, and acknowledges the importance of raising awareness about mental health in the Asian and Pacific Islander American community. Adopted

  • ACR 96, SCR 54 Recognizes May 2017 as National Mental Health Awareness Month in California to enhance public awareness of mental illness. Assembly version: Pending; Senate version: Adopted 

  • SB 94 Amends the California Controlled Substances Act, which makes various acts involving marijuana a crime except as authorized by law. As part of these amendments, this bill requires that a portion of the taxes from the sale of marijuana is spent on youth-focused substance misuse treatment that is culturally and gender competent and trauma informed. Enacted

  • SB 223 Requires a written notice of availability of interpretation services for health care services to be made available in the top 15 languages spoken by limited-English-proficient individuals in the state. Establishes qualifications for interpreters providing services to enrollees and insureds. Prohibits a health plan or insurer from requiring an individual to provide their own interpreter. Requires a plan or insurer to notify enrollees or insureds of language assistance and nondiscrimination protections. Extends language assistance services requirements to mental health plans. Enacted

  • SCR 66 Recognizes the month of July 2017 as Bebe Moore Campbell National Minority Mental Health Awareness Month. Adopted

     

Georgia
  • HR 367, SR 297 Recognizes Febr. 24, 2017, as Community Health Centers Day and commending the Georgia Association for Primary Health Care on its 40th Anniversary. House version: Adopted; Senate version: Adopted 

Hawaii

  • HB 767SB 384 Authorizes the board of psychology to grant prescriptive authority to prescribing psychologists who meet specific education, training, and registration requirements. The legislative intent points out that this legislation is an effort to provide access to Hawaii residents who may live in rural or underserved communities where mental health professionals with prescriptive authority are in short supply. House version: Pending - Carryover; Senate version: Pending - Carryover 

Idaho

  • HB 309 Appropriates funds from the Idaho Millennium Income Fund to the State Treasurer for distribution to the Idaho Youth Ranch, a family therapy and support center. The grant would provide for substance abuse prevention for children who are at a greater risk of abusing drugs and alcohol, among other uses. Also appropriates funds from the Idaho Millennium Income Fund to the State Treasurer for distribution to the Shoshone-Bannock Tribes of Idaho to establish peer recovery services at the Four Directions Treatment Center on the Fort Hall Reservation. States that the center currently has limited resources for prevention and recovery support services, and the grant will provide funding to hire a recovery services coordinator and train and certify recovery coaches. Enacted

Illinois

  • HB 763 Provides for specific financial commitment reporting requirements for completion of projects under the Health Facilities Act. It defines "safety net services" as services provided by health care providers or organizations that deliver health care services to persons with barriers to mainstream health care due to lack of insurance, inability to pay, special needs, ethnic or cultural characteristics, or geographic isolation. Safety net service providers include, but are not limited to, hospitals and private practice physicians that provide charity care, school-based health centers, migrant health clinics, rural health clinics, federally qualified health centers, community health centers, public health departments, and community mental health centers. Enacted 
  • HB 1786 Amends the Children's Mental Health Act of 2003. Creates the Children's Mental Health Local Integrated Fund Law. Creates local children's mental health collaboratives. Defines a "local children's mental health collaborative" as an entity formed by the agreement of representatives of the local system of care including mental health services, social services, correctional services, education services, health services, and vocational services for the purpose of developing and governing an integrated service system. Provides that in order to qualify as a local children's mental health collaborative and be eligible to receive start-up funds, the representatives of the local system of care and nongovernmental entities such as parents of children in the target population; parent and consumer organizations; community, civic, and religious organizations; private and nonprofit mental and physical health care providers; culturally specific organizations; local foundations; and businesses, or at a minimum one county, one school district or special education cooperative, one mental health entity, and one juvenile justice or corrections entity, must agree to the following: (1) to establish a local children's mental health collaborative and develop an integrated service system; (2) to commit resources to providing services through the local children's mental health collaborative; and (3) to develop a plan to contribute funds to the children's mental health collaborative. Pending
  • HB 3806 Amends the Alcoholism and Other Drug Abuse and Dependency Act; establishes the DUI Service Provider Effectiveness Program Exploratory Committee to create an audit and evaluation process that permits evaluation of treatment and intervention. As part of this, the committee is responsible for deciding the scope of information to include in the central publication that is available to DUI service providers. The central publication shall include the following resources; services that have multilingual capabilities or information on barriers to effectively teaching those who speak a different language, and how to access care for those persons with intellectual or physical disabilities or persons who require additional accommodations. Pending

Indiana

  • HCR 47 Recognizes the many contributions of the Indiana Minority Mental Health Professional Association, Inc. Adopted

Kansas

  • SB 100 Allows scholarships for mental health nurses, with preferential consideration given to minority applicants who otherwise qualify for this program. Enacted

Massachusetts

  • HB 495 Relates to alternative contract payments based on health care provider quality performance. This includes that a hospital rate increases shall be made contingent upon hospital adherence to quality standards and achievement of performance benchmarks, including the reduction of racial and ethnic disparities in the provision of health care. Such benchmarks shall be developed or adopted by the executive office of health and human services so as to advance a common national framework for quality measurement and reporting, drawing on measures that are approved by the National Quality Forum and adopted by the Hospitals Quality Alliance and other national groups concerned with quality, in addition to the Boston Public Health Commission Disparities Project Hospital Working Group Report Guidelines. Pending
  • HB 594 Provides the Office of Medicaid be directed to establish a bundled payment pilot program As part of this pilot program, in cases under the bundled payment pilot program that require the coordination of different health care services, including behavioral health treatment and services, and assistance in access to and cueing of services, the office shall designate an individual with expertise in providing such services to act as a case counselor for the patient. The case counselor shall have the cultural and linguistic competence appropriate to the patient to which he is assigned. The office shall determine the qualifications of such case counselors and the manner of their selection and appointment. Pending
  • HB 2382 Relates to the establishment of an adolescent substance use prevention and Early intervention trust fund within the Department of Public Health, to be funded by the excise tax imposed on marijuana products. States that the funds in the trust fund will be used to ensure the use of best practices in the prevention and reduction of adolescent substance use, and the identification and elimination of disparities related to substance use among diverse population groups. Pending
  • HB 2391 Relates to behavioral health integration. Requires the Health Planning Council to compile a list of all specialist, providers and facilities in the state and to publish that information on a public website. Requires that hospital rate increases shall be made contingent upon hospital adherence to quality standards and achievement of performance benchmarks, including the reduction of racial and ethnic disparities in the provision of health care. Such benchmarks shall be developed or adopted by the executive office of health and human services so as to advance a common national framework for quality measurement and reporting, drawing on measures that are approved by the National Quality Forum and adopted by the Hospitals Quality Alliance and other national groups concerned with quality, in addition to the Boston Public Health Commission Disparities Project Hospital Working Group Report Guidelines. Pending
  • HB 2633 Creates a tax on opioids sold in the state. Requires that the revenue from that tax be spent on several different programs including: establishing new addition treatment facilities, establishing sober living facilities, recruiting and increasing reimbursement for certified mental health providers providing substance abuse treatment in medically underserved communities or communities with high rates of prescription drug abuse, expanding access to long-term, residential treatment programs for opioid addicts, establishing or operating support programs that offer employment services, housing, and other support services to help recovering addicts transition back into society, establishing or operating housing for children whose parents are participating in substance abuse treatment programs, including capital costs, establishing or operating facilities to provide care for babies born with neonatal abstinence syndrome, including capital costs and other treatment programs, as the secretary determines appropriate. Pending
  • SB 600 Creates an Office of Health Equity to reduce and eliminate disparities in access to quality care and health outcomes based on race or ethnicity, religion, socioeconomic status, gender, age, mental health, cognitive, sensory or physical disability, sexual orientation or gender identity, geographic location or any other characteristic historically linked to discrimination or exclusion. Pending
  • SB 619 Creates a single-payer healthcare system in Massachusetts. As part of the system the Massachusetts Health Care Trust shall guarantee health care access to all residents without regard to financial or employment status, ethnicity, race, religion, gender, sexual orientation, previous health problems, or geographic location. The Trust shall provide coverage that is continuous, without the current need for repeated re-enrollments or changes when employers choose new plans and residents change jobs. Coverage under the Health Care Trust shall be comprehensive and affordable for individuals and families. It shall have no co-insurance, co-payments or deductibles. Pending
  • SB 1097 Requires that no less than three percent of all sums of revenue from marijuana be allocated to the Department of Public Health who shall establish an Adolescent Substance Use Prevention and Early Intervention Trust Fund. The trust fund shall be allocated by the Commissioner, consistent with substance use prevention programmatic recommendations of the Substance Abuse and Mental Health Service Administration and in consultation with the oversight committee to ensure the use of best practices in the prevention and reduction of adolescent substance use and the identification and elimination of disparities related to substance use among diverse population group. Pending

Minnesota

  • HB 237 Directs the commissioner of human services to establish a health care delivery pilot program created by or including North Memorial Health Care, targets groups with a higher incidence of poor overall health relative to the general population due to a combination of medical, economic, behavioral health, cultural, and geographic risk factors. Pending - Carryover
  • HB 887, SB 781 Relates to managed care, including behavioral health. Provides that managed care must be offered in each county, and that counties must be included in the process of development, and issuance of the request for proposals to provide services to eligible individuals within the proposed county. Requires that the following be considered: the RFP respondent's ability to fully and adequately deliver required health care services, offer an adequate provider network, provide care coordination with county services, and serve special populations, including enrollees with language and cultural needs. Also requires that the commissioner has methods to promote access and delivery of services in a culturally competent manner to each beneficiary, including a beneficiary with limited English proficiency, diverse cultural and ethnic background, disability, and regardless of gender, sexual orientation, or gender identity. Also relates to substance use disorder treatment. Requires that treatment services consider cultural differences of the client. House version: Pending - Carryover; Senate version: Pending - Carryover 
  • HB 945 Relates to human services, establishes the health and human services budget, modifies provisions governing health care, continuing care, health department and public health, children and families, health occupations, chemical and mental health, and opiate abuse prevention, establishes prescribed pediatric extended care center license, modifies certain definitions, establishes federally facilitated marketplace, repeals Mnsure, makes technical changes, requires reports. In the health and human services budget it creates an Alzheimer’s Disease Working Group. Requires certain membership on the Working Group including that the membership of the working group must reflect the diversity in Minnesota and must include representatives from rural and metropolitan areas and representative of different ethnicities, races, genders, ages cultural groups and abilities. Pending - Carryover 
  • HB 1186 Relates to human services, modifies provisions related to mental health services, modifies the definition of mental health practitioner, modifies certified peer specialist certification requirements, provides a mental health practitioner mush hold a bachelor's degree in one of the behavioral sciences or related fields, including, but not limited to, social work, psychology, sociology, community counseling, family social science, child development/child psychology, and community mental health. Defines a “culturally competent provider" as a provider who understands and can utilize to a client's benefit the client's culture when providing services to the client. A provider may be culturally competent because the provider is of the same cultural or ethnic group as the client or the provider has developed the knowledge and skills through training and experience to provide services to culturally diverse clients. It also requires that a mental health practitioners is fluent in the non-English language of the ethnic group to which at least 50 percent of the practitioner's clients belong. Enacted
  • HB 1414, SB 1421 Requires the Commissioner of Human Services to establish special demonstration projects for care networks that serve patient populations that experience significantly poorer health, higher risks of chronic disease, and poor quality and outcomes of care relative to the general population due to social, cultural and economic risk factors affecting population health and the delivery of care. States that these factors include poverty, homelessness, neighborhood or region of residence, mental health or substance use disorder, transportation barriers, and racial or cultural barriers. House version: Pending - Carryover; Senate version: Pending - Carryover 
  • HB 2101, SB 1798 Relates to human services, expands eligibility for child care assistance, modifies requirements for treatment prior to diagnostic assessments, expands multigenerational mental health services, appropriates money. States that the commissioner, in consultation with stakeholders, shall identify mechanisms to allow providers to provide a limited number of therapy sessions before conducting a diagnostic assessment for adults  and children from specific cultural communities, including refugrees and homeless youth. House version: Pending - Carryover; Senate version: Pending - Carryover
  • HB 2224 Relates to human services, establishes an intermediate school district mental health innovation grant program, appropriates money. Eligible applicants for the grant program include Indian Health Service facillities or facilities owned and operated by a tribe or tribal organization. Pending - Carryover
  • HB 2394 Relates to health, appropriates money for grants to prevent opioid overdoses in Minnesota's American Indian communities. Pending - Carryover
  • HB 2706 Relates to education, education finance, health, workforce development, increases appropriations for school-linked mental health services, provides for school staff and program development, requires an intermediate school district program evaluation, provides for additional supports for students attending alternative learning centers in intermediate districts, provides additional support for homeless students, creates professional development opportunities for staff who work with homeless students. Pending - Carryover
  • SB 160 Creates a comprehensive health care workforce council and workforce plan. Includes cultural competence and diversity in health professions education in the council's focus. Pending - Carryover
  • SB 800 Authorizes the continuation of a demonstration project to test alternative and innovative integrated health partnerships, and states that the request for proposals must allow maximum flexibility to encourage innovation and variation so that a variety of provider collaborations are able to become integrated health partnerships, and may be customized for the special needs and barriers of patient populations experiencing health disparities due to social, economic, racial or ethnic factors. Vetoed 
  • SB 1591 Relates to human services, modifies provisions governing chemical and mental health services. Creates a comprehensive assessment that to be administered face-to-face by an alcohol and drug counselor at a residential treatment program for substance use disorder. The comprehensive assessment must include sufficient information to complete the assessment summary. The comprehensive assessment must include information about the client's needs that relate to substance use and personal strengths that support recovery, including: age, sex, cultural background, sexual orientation, living situation, economic status, and level of education and several other points of information. This bill also creates an “Individual Treatment Plan” and requires part of that treatment plan include specific methods to address each identified need, including amount, frequency, and anticipated duration of treatment service. The methods must be appropriate to the client's language, reading skills, and cultural background. Pending - Carryover
  • SB 2050 Relates to health, appropriates money for grants to prevent opioid overdoses in Minnesota's American Indian communities. Pending - Carryover
  • SB 2322 Relates to human services, appropriates money for culturally competent mental health provider grants. Pending - Carryover
  • SB 2426 Relates to education finance, health, workforce development. Increases appropriations for school-linked mental health services. Appropriates funds for the Intermediate School District Mental Health Innovation Grant Program and includes Indian Health Service facilities and facilities owned and operated by a tribe or tribal organization as eligible applicants. Pending - Carryover 
  • H 2a Appropriates funds for the Intermediate School District Mental Health Innovation Grant Program and includes Indian Health Service facilities and facilities owned and operated by a tribe or tribal organization as eligible applicants. Enacted
  • S 2a Requires the implementation of a written quality strategy for assessing and improving the quality of health care and other services provided by managed care organizations. The quality strategy must include a plan to identify, evaluate and reduce health disparities based on an enrollee's age, race, ethnicity, sex, primary language or disability status, and provide this demographic information to the managed care organization at the time of enrollment. Enacted

Montana

 

  • SB 233 Revises laws regarding the authority of the department of public health and human services to adopt rules relating to the provision of Medicaid services to children in foster care, provides that the department may not adopt rules that exclude or restrict foster children from accessing Medicaid services solely because the children are in foster care. Requires that home and community-based services shall strive to incorporate the encouragement of culturally sensitive and appropriately trained mental health providers. Enacted

New Jersey

  • AB 1875 Requires that the Division of Mental Health and Addiction Services in the Department of Human Services, shall develop, coordinate, implement and oversee a comprehensive multicultural public awareness campaign, to be known as the "Heroin and Opioid Drug Public Education (HOPE) Initiative," which shall allow for the coordinated and widespread dissemination of information designed to combat the growing heroin and opioid epidemic in this State. Pending

New Mexico

  • HM 45, SM 19 Declares Feb. 15, 2017, Behavioral Health Day in the House of Representatives and Senate. States that many New Mexicans affected by and advocating on behalf of those with behavioral health disorders work to ensure that behavioral health services are provided in a culturally appropriate manner. House version: Adopted; Senate version: Adopted  

New York

  • AB 1109, SB 3256 Establishes peer crisis diversion homes, requires the commissioner to establish or contract for no fewer than six peer crisis diversion homes within one year. Also requires the commissioner of mental health to provide formal guidelines for training and certification of peer support specialists, including certifying that peer support specialists have completed training in cultural competency and race relations, among other topics. Assembly version: Pending; Senate version: Pending 
  • AB 1890, SB 3981 Makes care and services provided by licensed mental health practitioners eligible for coverage under the Medicaid program. In the legislative intent for this bill it states the following: “Whereas Medicaid covers mental health services in New York state to psychiatrists, psychologists and social workers, Medicaid does not recognize New York state licensed mental health practitioners as providers within the Medicaid program. Mental health practitioners are often the only mental health providers in urban underserved minority communities. A critical result of this lack of providers is that minority communities bear a disproportionate number of burdens of mental health disabilities and inadequately treated mental health disorders. Excluding mental health practitioners from treating Medicaid beneficiaries with untreated mental illness puts such beneficiaries disproportionately at risk for engagement with the criminal justice system. This puts individuals, families and communities at risk of harm. Approximately 26 percent of adults experience a diagnosable behavioral health disorder each year, and researchers have reported 20 percent of adolescents display psychological problems. Behavioral health disorders, ranging from inattention to violence are often a result of those psychological problems.” Assembly version: Pending; Senate version: Pending 
  • AB 2818, SB 3286 Enacts the Minority Mental Health Act to establish the division of minority mental health within the office of mental health, provides that such division shall be responsible for assuring that mental health programs and services are culturally and linguistically appropriate to meet the needs of racial and ethnic minorities. Assembly version: Pending; Senate version: Pending 
  • AB 4738, SB 4371, SB 4840 Establishes the New York Health program, a comprehensive system of access to health insurance for residents, provides for administrative structure of the plan, provides for powers and duties of the board of trustees, the scope of benefits, payment methodologies and care coordination, establishes a Health Trust Fund which would hold monies from a variety of sources to be used solely to finance the plan, enacts provisions relating to financing. Assembly version: Pending; SB 4371: Failed; SB 4840: Pending  
  • AB 8150 Establishes the council for treatment equity within the office of alcoholism and substance abuse. Pending

Pennsylvania

  • HR 141 Designates the month of May 2017 as Mental Health Awareness in the Black Community Month in Pennsylvania in conjunction with the 2017 Black Brain Campaign being held in Philadelphia. Adopted
South Dakota
  • SB 3 Makes an appropriation to the Department of Health for the administration of a program to address methamphetamine and other substance abuse issues among students. States that the program will target Native American students through multiple forms of media. Failed - Adjourned
Texas
  • HB 1 States that it is the intent of the Legislature that the Center for Elimination of Disproportionality and Disparities (CEDD) shall advise each health and human services agency within Texas Health and Human Services System (HHS) on the implementation of cultural competency training, technical assistance and consultation, and develop partnerships with community groups and agencies to support the delivery of culturally appropriate services to children and families. Failed - Adjourned

Washington

  • HB 1661, SB 5498 Creates the Department of Children, Youth and Families. Requires the Department of Children, Youth and Families to establish short- and long-term population level outcome measure goals, including metrics regarding reducing disparities by family income, race and ethnicity. States that the Legislature finds that children and youth of color are disproportionately impacted at every point in the child welfare and juvenile justice systems. Also states that the Department of Children, Youth and Families must prioritize addressing equity, disproportionality and disparity in service delivery and outcomes, and provide transparent, frequent reporting of outcomes by race, ethnicity and geography.  House version: Enacted; Senate version: Pending - Carryover 
  • HB 1713, SB 5763 Implements recommendations from the children's mental health work group, encourages providers to use behavioral health and other therapies that are empirically supported or evidence-based and only prescribe medications for children and youth as a last resort, requires the coordination of resources and services through the managed health care system and tribal organizations providing health care services. States that the Legislature finds that children and their families face systemic barriers to accessing necessary mental health services. These barriers include a workforce shortage of mental health providers throughout the system of care. Also states that of particular concern are shortages of providers in underserved rural areas of the state and a shortage of providers statewide who can deliver culturally and linguistically appropriate services. House version: Enacted; Senate version: Pending - Carryover  
  • SB 5779 Concerns behavioral health integration in primary care, requires a multifaceted approach to implement sustainable solutions for the integration of behavioral and physical health, requires the authority to complete a review of payment codes available to health plans and providers related to primary care and behavioral health. States that integrating behavioral and primary health is a foundational strategy to reduce health disparities and provide better care coordination for patients regardless of where they choose to receive care. Enacted 

Wisconsin

  • AB 112 Relates to grants for treatment and diversion programs. States that grants that the Department of Justice provides to counties for programs that offer alternatives to prosecution and incarceration for persons who use alcohol or other drugs may also be provided to tribes for the same purpose. Pending

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