Why can’t people afford mental health services?

My understanding is that every state offers some form of Medicaid for people who can't afford the premiums of another health plan. And my understanding is that every health plan, including Medicaid, has to cover mental health services on par with physical health services. So I'm interested to know why people say they can't get mental health services because they can't afford it. Below are some potential theories. I'd be interested to know about specific real-life instances/data that you know of, for these or other causes.

Some Medicaid plans actually don't cover mental health. Some Medicaid plans only cover a limited number of sessions, not enough for what people need (typically weekly sessions on an ongoing basis). Some Medicaid plans have high copays for mental health services, effectively putting them out of reach for low-income people. Some Medicaid plans require you to have a formal diagnosis before they cover mental health, and that's hard (or expensive) for people to obtain. Some Medicaid plans have such a limited selection of therapists, or such a bureaucratic matching process, that for practical purposes most people can't find a therapist who is available. The therapists that are covered by Medicaid tend to be of such low quality that it's like not having therapy at all. The time and gas to drive to a therapist and, for instance, find child care in the middle of a weekday makes it so that many low-income people can't do it because they can't take time off from their job or afford child care.

(I do understand that many people who need mental health services don't access them because of substance abuse or several mental health issues. But here I'm just focused on financial reasons, where people want to see a therapist but can't afford it.)

submitted by /u/parseroftokens
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