Tag: mental health

What C.K. v. McDonald Mean for Children’s Mental-Health Access Through Medicaid

In August, it was announced that a landmark settlement agreement, was reached in a New York class action lawsuit against the New York State Department of Health (NYSDOH) and the New York State Office of Mental Health (NYOMH). This settlement follows settlements of similar cases in Michigan and Iowa, showing a movement towards systemic change for youth mental health and children’s advocacy. In C.K. v. McDonald, filed in 2022 by children and disability rights groups on behalf of four children in the U.S. District Court for the Eastern District of New York, the plaintiffs alleged that federal law requires mental health services be made available and provided through a state’s Medicaid program, yet, New York State’s services were “inadequate, inaccessible, and dysfunctional.” The plaintiffs primarily alleged that New York systematically denied Medicaid-enrolled youth access to community-based mental health care, which violated their federal rights and left them at risk of institutionalization and long-term harms. The complaint highlighted that the failure of NYSDOH and NYOMH disproportionately effect youth from low-income households and children of color.

Specifically, the plaintiffs cited a number of federal requirements that New York state was not adhering to, including the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) provision, which requires that Medicaid beneficiaries under 21 receive a number of medical services, including mental health care. The plaintiffs also brought claims under Title II of the Americans with Disabilities Act (ADA), which, under 28 C.F.R. § 35.130, prohibits discrimination or exclusion of qualified individuals from participation in services of a public entity by reason of disability.  The plaintiffs noted that 29 U.S.C. § 794 maintains identical requirements for any program or activity that receives Federal funding. Finally, the plaintiffs cited to Olmstead v. L.C., where the Supreme Court held that the ADA requires states to “provide community-based treatment for persons with mental disabilities.”

 The settlement agreement outlines an 18-month plan of action that the State must implement to improve mental health services for children. The plan establishes that agencies must provide intensive care coordination, in-home behavioral health services, and crisis response planning that does not rely on police. Additionally, the settlement establishes that the State must increase Medicaid reimbursements and institute annual quality audits of these services. The State will also initiate screening and assessment for children who are eligible for services and ensure that an expert is hired in tracking New York’s progress in meeting the agreements of the settlement.

While the settlement is awaiting the court’s final approval, the case outcome demonstrates progression towards improvements in mental health care for the 2.5 million children under 18 who are enrolled in New York’s Medicaid. This step addresses a major gap in care for some of the State’s most vulnerable residents, who so often have to rely on hospitals and residential facilities for care rather than in-home and communal services, which can be extremely distressing and traumatizing. Beyond New York, this case represents  systemic challenges that have been prevalent throughout the country for decades. The New York case, as well as the Michigan and Iowa cases, reinforce a legal precedent that States must be held accountable for providing meaningful, community-based mental health services that are non-discriminatory for Medicaid-eligible and enrolled children. Given the threats to Medicaid funding and massive financial cuts at the Federal level, it is more important than ever that Medicaid funds be spent on proven and effective services.

Mental Health Parity: A Question of Agency Authority

A recent legal challenge to a key mental health parity law sparks conversations about federal agencies’ power to interpret and enforce statutes. Earlier this year, the Employee Retirement Income Security Act Industry Committee (ERIC) filed a lawsuit against the Department of Health and Human Services (HHS), the Department of Labor (DOL), and the Treasury, regarding the enforcement of the updated 2024 Mental Health Parity and Addiction Equity Act (MHPAEA).

MHPAEA was enacted in 2008 to address disparities in benefits between mental health or substance use disorder (MH/SUD) treatment and medical/surgical (M/S) services. Under MHPAEA, MH/SUD treatment and financial limits must not be more restrictive than those for M/S services, and MH/SUD benefits cannot have separate limits that are not also applied to M/S benefits. In practice, the law required health plans and healthcare facilities to cover MH/SUD services in the same way as M/S services. 

A 2013 Rule updated MHPAEA, clarifying ambiguity about parity for non-quantitative treatment limits (NQTLs), such as prior authorizations, network adequacy, medical necessity standards, and step therapies. This Rule also confirms that parity applies across all care levels, including outpatient, inpatient, and “intermediate” behavioral health settings. 

Enforcing compliance with insurance plans under MHPAEA was difficult because the Act did not require strong proof of adherence. The 2021 Consolidated Appropriations Act (CAA) addressed this issue by requiring a comparative analysis of health plans to demonstrate parity between MH/SUD and M/S services, specifically NQTLs, and by allowing federal agency audits and on-demand submissions from health plans. 

The 2024 Final Rule aimed to improve enforceability further and reduce ambiguity across employer plans (ERISA), ACA marketplace plans, and Managed Care plans through several new standards: requirements to report NQTL comparative analysis data to federal agencies and beneficiaries with clear explanations, fiduciary certification for ERISA plans, a more detailed NQTL collection and reporting process, and a standard that ensures plans offering any MH/SUD benefits provide meaningful material benefits in every classification that the plan also offers M/S benefits. 

ERIC filed a lawsuit on January 17, 2025, with several allegations against the implementation of the 2024 Final Rule. First, ERIC argued that the Final Rule is too vague in guiding the collection and reporting of NQTL outcome measures and in addressing and fixing material differences in MH/SUD and M/S benefits. ERIC also claimed that many of these measures, now required for collection, could be affected by external factors that might hinder payers’ ability to remain compliant.

Additionally, ERIC questioned the scope of the Final Rule, arguing that the 1:1 requirement for MH/SUD and M/S benefits across all classifications exceeds the Act’s scope and intent. Finally, ERIC challenged the applicability date of January 1, 2025, claiming that it offers too little time for employers/agencies to make the necessary adjustments to comply. Throughout their complaint, ERIC argued that HHS, DOL, and the Treasury violated the Administrative Procedure Act by creating and enforcing what they describe as a vague and overbroad regulation. 

On May 12, 2025, the U.S. District Court for the District of Columbia agreed to stay ERIC’s lawsuit after the Tri-Agencies made a motion for abeyance to consider rescinding or modifying the 2024 Rule. The agencies also issued a non-enforcement policy for the components of the Rule that took effect in January 2025 or were set to take effect in 2026.

Several advocacy organizations and provider-focused trade associations have criticized the decision not to enforce, claiming that it harms agencies’ ability to implement and enforce aspects of the 2021 additions to MHPAEA, while also inhibiting critical steps to ensure more detailed analysis of parity and leaving room for health insurers to take advantage of potential loopholes.

Following the Supreme Court’s decision in Loper Bright v. Raimando, debates over federal agency authority and explicit statutory authorization requirements have become more common. ERIC’s complaint, in large part, focuses on concerns regarding agency overreach in interpreting and enforcing statutes. Lawsuits like this are likely to play a part in setting a precedent for what constitutes an acceptable scope for federal agency interpretation and enforcement of statutes governing their authority.

Tribal Youth vs TikTok: The Fight to Protect Native American Mental Health

As technology becomes more salient in everyday life, American youth now collectively spend more time on screens than any other leisure activity. In fact, around half of American teenagers ages 12-17 self-reported four or more hours of screen time per day. Of those teenagers with four plus hours of screen time, about 25% of them showed symptoms of anxiety or depression in the past two weeks. 

The negative effects of adolescents’ high exposure to screen time are well researched, particularly its negative effects on mental health. Studies have shown that excessive screen time exposure increases the risk of depression, sleep disorders, social isolation, and other mental health issues among children and adolescents. Between 2017 and 2019, social media, one of the main sources of screen time, was associated with 30% of adolescent suicides, the leading cause of adolescent death.

A particularly vulnerable group to struggles with mental health is Native American communities. Out of all ethnoracial groups, Native Americans have the highest rates of mortality from deaths of despair (e.g., suicide, overdose, alcohol-associated liver failure). A long and dark history of oppression, forced assimilation, and violence has left thousands of Native Americans suffering from multi-generational trauma, manifesting itself in mental illness, substance use disorders, and suicide. Despite the increased need for mental health services in Native American communities, many barriers continue to limit access. Lack of funding, poverty, rural and isolated locations, mistrust in government services, and mental healthcare providers’ lack of cultural competency are only a few of the many ways access to mental health care is restricted. The historic and continuous discrimination of Native American peoples, coupled with the barriers to mental health care services, leaves these communities in a unique position of vulnerability.   

The epidemic of social media has been felt acutely amongst many Native American tribes. On September 15, 2025, the Chickasaw Nation became the latest of about half a dozen Native American Tribes to lodge claims against social media platforms. These claims allege the companies’ products (Facebook, TikTok, Instagram, etc.) are harming their youth, who are already at disproportionate risk of mental health problems and suicidal ideation. The suit claims that social media platforms design their product to addict young users and profit from their addiction. Approximately 65% of tribal youth spend three to seven hours a day on social media, reporting difficulties with time management and impulse control related to social media use. On January 8, 2025, an Apache tribe filed an extremely similar suit, alleging that these platforms have put profit above all else at the expense of the cognitive development of the tribe’s children and their vulnerability to mental health problems. 

The uptick of cases filed by Native American tribes is a small part of a larger trend in the legal community aiming to hold social media companies accountable for designing their platforms to be addictive to children and adolescents without warning of the mental and physical harm that follows. While companies like Meta, the owner of Instagram and Facebook, have made efforts to improve the safety of young users, such as Parental controls, many claims have introduced evidence suggesting their safety initiatives are little more than PR stunts. It will be crucial for regulators and lawmakers to consider the evidence produced from these lawsuits when making important decisions about the future of social media regulations.

Years of published research have time and again shown that increased social media use can lead to concerning mental health issues among children and adolescents, especially among populations who are already at an increased risk. Yet social media companies are failing to protect their most vulnerable users, children. The trend in Native American tribe suits against social media tycoons is not only crucial in repairing, restoring, and preventing the mental health crisis among young Native Americans but also a crucial step in protecting vulnerable children and adolescents across the country.

The Telehealth Cliff: Implications of Expiring COVID-19 Waivers

During the COVID-19 public health emergency, the U.S. government enacted a series of telehealth waivers that significantly expanded access to remote healthcare services. These changes were designed to address barriers to care during a time when in-person medical visits carried heightened risks of infection. By relaxing long-standing restrictions and broadening the scope of telehealth, policymakers ensured that millions of patients could continue receiving essential medical care. However, because many of these waivers were temporary, the nation does face a policy crossroad as expiration deadlines approach.

Prior to the pandemic, telehealth under Medicare was restricted by geographic and originating site limitations. Patients typically had to be in a rural area and physically present at a medical facility to access telehealth services. The COVID-19 era waivers removed these restrictions, allowing patients to receive telehealth services from the comfort of their own homes and in any location. This shift significantly expanded access, particularly for vulnerable populations, including the elderly, individuals with mobility challenges, and those living in underserved areas.

The waivers also expanded the scope of providers eligible to deliver telehealth services. Physical therapists, occupational therapists, speech-language pathologists, and audiologists were temporarily authorized to bill for telehealth services. Federally Qualified Health Centers (FWHCs) and Rural Health Clinics (RHC) were permitted to serve as distant site providers, further expanding the pool of available telehealth practitioners. Behavioral health care received significant support as well, with relaxed requirements for in-person visits and broader acceptance of telehealth for mental health treatment.

One of the most transformative flexibilities was the inclusion of audio-only telehealth visits. Recognizing that not all patients had access to reliable broadband or video technology, regulators allowed providers to conduct visits via telephone. This proved particularly valuable for low-income and rural patients, helping to close the care delivery gaps.

Prescribing of controlled substances via telehealth also saw temporary adjustments. The Drug Enforcement Administration (DEA) relaxed requirements for in-person visits before issuing prescriptions, which allowed patients to continue receiving critical medications for conditions such as ADHD, anxiety, and opioid use disorder.

As the public emergency wound down, Congress took steps to extend many of these waivers. The American Relief Act of 2025 extended telehealth flexibilities through March 31, 2025, while the Full-Year Continuing Appropriations and Extensions Act pushed the deadline to September 30, 2025. Yet, unless further action is taken, and right now none has, these waivers are set to expire, which creates what some policy experts call a “telehealth cliff.”

If these waivers expire without replacement, access to telehealth will narrow significantly. Medicare patients may once again be limited to receiving telehealth only in rural areas and from specific originating sites, reducing the ability to access care from home. Audio-only visits would no longer be reimbursed, excluding patients without video technology. Non-physician providers may lose the ability to conduct telehealth visits, shrinking the range of available services. Additionally, the more flexible rules for prescribing controlled substances remotely would tighten, requiring more in-person visits.

Now that the expiration date has passed, critical questions about the future of telehealth remain. Supporters argue that the waivers demonstrated telehealth’s effectiveness and necessity, especially in addressing disparities in access to care. They emphasize that removing these flexibilities would disproportionately harm patients in rural, underserved, and low-income communities. Policymakers have responded by introducing proposals such as the Telehealth Modernization Act, which would extend many of these flexibilities through 2027.

The telehealth waivers enacted during the COVID-19 pandemic represented a historic transformation of the US health care system. They expanded access, reduced barriers, and highlighted the potential of telehealth as a permanent feature of modern care delivery. Yet, now with the expiration day has passed, the nation must decide whether to preserve these gains or return to a more restrictive system. The outcome will shape the accessibility, equity, and effectiveness of healthcare for millions of Americans.

From Counsel to Counselor: A Brief Overview of the Legal Profession’s Relationship with Mental Health

People joke that being an attorney sucks the life out of you. And frankly, it does. There is a high mental and emotional toll on legal professionals. A 2016 survey from the American Bar Associationfound that “21-36% of lawyers qualify as problem drinkers, approximately 28 percent of lawyers are struggling with some level of depression, and approximately 19 percent are struggling with anxiety.” These rates are especially high among young lawyers in firms. A North Carolina studyreported that one in every four attorneys displayed symptoms that would indicate clinical depression, such as a loss of appetite, lethargy, insomnia, or suicidal thoughts. The percentage of legal professionals battling substance abuse is almost twice as highas the general population. The general attitude towards lawyers from both the public and the community itself is one of resignation: lawyers are workaholics, egotistical, soulless, etc. But what changes within the community can positively impact the wellbeing of legal professionals? Can improvements in the ways lawyers handle mental health shift public perception of the occupation? 

The environment inherent in the legal profession can have a lasting impact on anxiety and depression.Work in the legal profession includes time constraints, high stakes (loss of property, freedom, life), and high expectations from peers and clients. Deadlines never really end for lawyers; even when one case closes, many others open and there is always an impending due date. The perpetual threat of malpractice leaves no room for lawyers to make mistakes. The constant scrutiny, judgment, competition, and conflict-driven nature of the occupation obstruct the formation of professional relationships and camaraderie. Oftentimes these strains extend past the courthouse and into the personal lives of lawyers, such as a depletion of energy, an inability to stop worrying about the work, and the tendency to argue their point at any given moment. 

These factors are such an integral part of the profession that many of them begin to manifest even in law school. The effects of these pressures are felt by a majority of students at some point in their education. The Survey of Law Student Well-Being in the spring of 2014showed that 17% of law students experience depression, 14% experience severe anxiety, and 43% of students report binge drinking at least once in the last two weeks. These numbers are especially high among men and continue to climb with each year of law school. These statistics are staggering. They demonstrate that young professionals entering the workforce are already in the mindset that their mental health and well-being should take a backseat to their career, success, and work. 

The remedy is no quick fix; it involves community-wide changesto the culture and mentality of how to be a successful lawyer. To start, the profession must learn to acknowledge and recognize the mental health struggles facing many lawyers. Leaders should value well-being and act as role models—not only from a business perspective, but a personal one. By destigmatizing and encouraging open communication about the mental health issues faced by the community, people may start to feel comfortable asking for help when they are burned out or depressed. When firms stress billable hours as success, they encourage overtime and discourage a work-life balance, which is necessary in mental health. There are several well-being programs that can be introduced both in the firm and outside that build teamwork, camaraderie, and collegiality. For example, there is a Lawyer Assistance Program at the D.C. Bar that is free and assists those in the legal community with issues like addiction, stress, and mental health symptoms. 

The legal profession’s relationship with booze should also be reevaluated.Social events, meetings, job recruitment, and mentorship generally occur over the consumption of alcohol, even beginning as early as law school. Addiction prone lawyers may jeopardize their sobriety in order to attend networking and social events, under the pressure that these events are necessary for promotions and positive office relations. 

Lawyers are skilled in managing risk, but lawyers have repeatedly failed to recognize that their community is the one at risk. So, then, why is it so difficult for lawyers to recognize that their community is the one at risk? The current structure and culture leave no room for well-being or mental health. To ignore this problem any longer is to continue to put lawyers, clients, firms, and the profession as a whole in jeopardy.  

Connecticut To Improve Mental Health Support in Public Schools

Since the Newtown shooting, the national discourse on mental health and treatment has been at the forefront of political interest. Connecticut is currently reviewing a chance to improve mental health policies in public schools.

While President Obama is developing a plan to provide $15 million for training school teachers and officials to recognize and deal with students with mental health issues, Connecticut is looking towards supplementing that plan with more social workers in schools.

Senator Beth Bye points out, “We need people in the schools to be more aware of kids who are dealing with social and emotional issues. Early intervention does make a difference.”

Connecticut does not currently allow involuntary outpatient treatment, but change is in the air. It is only one of six states that prohibits this type of treatment.

Some advocates are concerned that improvement to the mental health industry is coming on the heels of a violent tragedy. Those with mental illness are more likely to be victims of violent crimes, they warn, more than they are likely to be the perpetrators. Conflating mental health with violence does more harm than good, to the detriment of all.

As Victoria Veltri, the state’s healthcare advocate, says, “The system needs a lot of work but it’s not because of what happened on Dec. 14… People may be unintentionally equating gun violence with having a mental health diagnosis. Gun violence is its own public health crisis.”