Medi-Cal Expansion Offers Young Adults Hope in Battling Depression

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SAN FRANCISCO -- "At least now I know what I'm fighting, it's called depression," said Sam Charles, 23, about the last six months of counseling he's received from a therapist at a shelter for transitional youth here in the city.

Charles says he's felt like he's been dealing with depression most of his life, but it became incapacitating after he was shot in the leg in 2011 and the ER doctors at Sutter Health removed fragments but left most of the bullet inside.

"I didn't have health insurance," he explained.

Now he's enrolling in Medi-Cal, California’s name for Medicaid, the federal-state health insurance program for low-income people, with the hope he can get regular treatment, and remove the bullet from his leg.

Charles is typical of some 21 percent of young adults who experience a severe emotional disturbance in their teen years, according to the National Institute of Mental Health. Yet, only half who have mental disorders receive professional treatment.

Depression is the most common mental disorder in both young and old Americans, said Rusty Selix, executive director of the California Council of Community Mental Health Agencies (CCCMHA).

Today, with Medicaid expanding under the Affordable Care Act (ACA), and public and private health plans required to provide equal coverage for mental health and substance abuse disorders, as they do for medical and surgical care, an estimated 32 million people nationwide will have access to mental health services, according to the U.S. Department of Health and Human Services. This includes young childless adults who earn less than $16,000 a year who, for the first time, are eligible for Medi-Cal coverage.

Mental health and substance abuse disorder services are one of the 10 essential health benefits outlined by the ACA, and must be covered by plans participating in Medi-Cal managed care and the on line marketplace called Covered California. Rehabilitative services and prescription drugs must also be offered.

Surge in interest to get health coverage

Since Jan. 1, 2014, youth shelter counselors and clinicians in Oakland and San Francisco report seeing a surge of interest among their clients seeking access to health services, especially for mental health care. Margo Levi is clinical director with Huckleberry Youth Programs here in the city. The agency provides mental health care for both insured and uninsured clients.

"People who didn't have Medi-Cal before are now showing up with it," Levi said. Huckleberry is in the Medi-Cal network.

Donny Lumpkins, a 26-year-old childless adult, didn't waste any time when he found out last December that he could enroll in Medi-Cal.

Two years ago, Lumpkins was forced to quit his part-time job with a nonprofit in San Francisco after "crippling depression" and other health issues made him feel "all cemented up." There were days, he said, "I felt like I was blind-folded, like I was nowhere, like my arms and legs had been cut off."

Now, after just a few counseling sessions and medication, he is eager to resume his job search. "For the first time in a long while, I am able to think clearly," he said.

Not everyone who has depression even knows it. That's because "the negative moods come gradually and they don't recognize it as a mental illness," said Selix of CCCMHA. When it gets serious, people around them start noticing, he said.

Charles thought he's been dealing with "a weird mental condition" most of his life that he believed was caused in part by growing up in a dysfunctional family.

“I didn’t think I needed to worry about how I felt,” he said. “I didn’t think it was an issue.”

He often found himself homeless, he said, and that made it harder for him to cope with his inner demons. Part of the problem was also the stigma attached to mental illness.

San Diego psychiatrist Dr. Rodrigo Munoz noted that most people prefer to keep their mental illnesses under wraps because of the stigma attached to it. They suffer in silence.

Charles was one of them. He worried what people would think if he told them about his disorder. “So I didn’t come out and say anything. Now I realize you need to open up if you want to get better.”

Lavette Williams, a single mother of a 14-month-old daughter, aged out of Medi-Cal insurance last September when she turned 21. She supports herself and her child on her $800 monthly SSI checks and $300 a month earned as a part-time security guard. She has been suffering from depression since her only brother was fatally shot in 2010.

Two weeks ago, Williams applied for Medi-Cal, after someone told her she could get back on it because she earned so little. Now that she’s a mother she wants want to get her life back on track, something she believes she can do with a little counseling.

"Therapy costs a lot of money, and having Medi-Cal will come in handy," she said.