The Affordable Care Act is all about getting people health insurance. Once they're insured, there's another hurdle: getting them access to care. That's a particular problem for people living on low incomes.
It's even more of a problem for the poor who seek behavioral health care.
Pamela McGuire's office is on what is affectionately known as therapy row: Prospect Avenue on the Hartford and West Hartford line. She's a licensed clinical social worker, and she's never submitted testimony to the legislature before. She did this time.
"I decided to do this," McGuire said, "because I had a face. I had voices. I had names of real people who I'm connected to who I knew would benefit." She and others want the state to allow those living on low incomes to see private psychologists and licensed clinical social workers for therapy.
As it stands now, single adults on Medicaid can only see those care providers at certain outpatient clinics and health centers. McGuire said that while there may not be a huge difference in the quality of care between a clinic and a private practitioner, there is a big difference in terms of access to that care.
McGuire said, "For your intake appointment, or for your medication appointment, the average wait at a clinic is two to six months. Usually, a [private] practitioner can see you within one or two weeks."
A bill is before the state legislature that would fix this issue, but officials said it won't move forward this year. Governor Dannel Malloy's administration opposed it, because the measure isn't funded in the budget.
David Dearborn, a spokesman for the state's Department of Social Services, said that the state wants to work with the federal government to make sure people can access the care they need. He said there could be movement soon. "We're using the term 'as soon as possible,'" he said, "which, in state government, means pretty quickly."
Dearborn emphasized that Medicaid does in fact cover the same therapy in clinics. "It's not like the service is not available," he said. "Yes, it will expand the access to private practice psychologists, which may seem like a technicality to some. For others, it does present the potential and likelihood where we'll be able to bring, in a more holistic way, all of these services under the banner of Medicaid."
Victoria Veltri, the state's health care advocate, said changing the current practice is important, in no small part because the state just enrolled a lot of new Medicaid recipients.
"The idea is to improve access," Veltri said. "Remember, we just enrolled about 120,000 people into Medicaid through the Affordable Care Act. We will need to be able to improve access to behavioral health services for people."
Daniela Giordano, public policy director for NAMI CT -- that's the state's arm of the National Alliance on Mental Illness -- said access to care isn't just an issue for those living in major city centers. Low-income adults living in rural Connecticut face challenges of their own.
"In some areas in Connecticut," Giordano said, "especially the more rural areas, there may not be a clinic. This option of actually being able to see somebody in a private practice -- which may be much more available, and much closer to where you live in the rural areas -- that is something we support for people to actually get services, once they do have insurance."
McGuire treats people living with depression, anxiety, personality disorders, and people going through life crises. She turns away a couple dozen adults on Medicaid a year, because the state doesn't cover her services. She thinks the current system is bad for care. "Therapy is about the relationship," she said. "It's not easy to enter into a therapeutic relationship. Usually, you have to admit that something isn't working, or that you need help. To have to do that every other year, when your insurance changes, with a new person can be devastating."
It's McGuire's hope that, with or without legislation, the state will move quickly to make therapy more accessible for the poor.