Mental Health Blog

Mental Health Care for Under- or Uninsured Pediatric Patients

• June 26, 2025
• The REACH Institute
• Child mental health, Coding, High-risk children & youth, Pediatric primary care

“Evaluating and treating mental health problems in under- or uninsured pediatric patients often presents more challenges, but it is even more rewarding when you are able to provide life-changing mental health care,” explains Natalie Robiou, MD, a pediatric primary care provider at a Federally Qualified Health Center (FQHC) in Philadelphia, PA. 

The number of pediatric patients in this population is staggering. As of early 2025, 37 million children are covered by Medicaid or the Children’s Health Insurance Program (CHIP). More than 4 million children have no health insurance coverage at all. Research also suggests there are likely an additional 24 million underinsured children—kids who have health coverage but whose families may not seek or maintain care due to barriers like limited provider networks and high out-of-pocket costs. 

We asked Dr. Robiou, a 2024 PPP (Patient-Centered Mental Health in Pediatric Primary Care) scholarship recipient and current member of REACH’s Alumni Leadership Council, about the most effective strategies she’s found for providing mental health care to these populations. 

Screen Early and Often

While screening for mental health disorders is important for all pediatric patients, for uninsured and underinsured patients, it’s especially essential to screen early and often. “By catching mental health problems early, we can hopefully prevent more severe problems later, when they are harder to manage,” Dr. Robiou explains. 

Use Inclusive Screeners and Multilingual Resources

Many of the uninsured patients Dr. Robiou sees are immigrants and may not be fluent in English. Having a translator available or validated screening tools and mental health resources available in languages commonly spoken in local immigrant communities can prevent a mental health disorder from being missed. 

Assess for Trauma 

Within communities where patients are more likely to be uninsured or underinsured, clinicians should be more mindful of trauma, which increases the risk of mental health disorders, and use a trauma-informed care model. 

“Trauma is a topic that is hard for patients to process and discuss,” explains Dr. Robiou. “But clinicians can work to develop a good rapport with the patient so that, over time, they will be more likely to open up about past traumas.” 

Be Prepared for Challenges 

Challenges like higher no-show rates for uninsured patients and those on Medicaid can hinder care. Many patients in this population are in households where parents or caregivers may be working more than one job, caring for multiple generations, dealing with language barriers, relying on public transportation, or managing through prior negative healthcare experiences. Appointments that include mental health components can also be draining for families, as it can feel like reliving prior trauma.

Since in-person visits can be difficult for these patient populations, Dr. Robiou adds virtual follow-up appointments wherever possible. To improve success in contacting patients, clinicians or other staff can confirm or update patient phone numbers at every visit and ask for a second “backup” phone number. 

Understand Costs When Prescribing 

Prescription copays can easily deter patients from following treatment protocols. For patients on Medicaid or CHIP, most prescriptions have very low or no copays, though providers may need to get preauthorizations or go through appeals processes for non-formulary medications. 

For patients without insurance or on private plans, clinicians can help them find prescription discounts with tools like GoodRX or CostPlus Drugs. If a patient needs an expensive or non-formulary medication, prescription assistance programs from pharmaceutical companies can help with costs for eligible low-income households. 

Help Patients Find Appropriate Specialist Care

Patients with limited insurance or on Medicaid often struggle to find specialists who will accept them, and wait times for those specialists can be extremely long. Plus, extensive legwork is sometimes needed, which requires time and proficiency in English—a challenge for some families. 

To help patients in need of specialist support, providers can: 

• Use Behavioral Health Navigators: A behavioral health navigator works on behalf of the patient, finding appropriate providers who will not only accept the patient but who are geographically accessible and can meet any language or translation needs. 
• Know Your Local Resources: For some states, organizations such as the Children’s Advocacy Project of America (CAP4Kids) track and organize accessible resources in real-time. Most states also have Child Psychiatry Access Programs (CPAP) that clinicians can call to speak with a psychiatrist directly about specific patient cases. 
• Connect Patients with School-Based Resources: If the local school district has adequate psychiatrists or counselors, they can provide free and accessible counseling services. Building a relationship with schools in advance can help streamline referrals. 
• Use Time-Based Billing for Time Spent Finding Patient Services: Depending on billing practices, time spent calling around to find resources for a patient may be included in time-based billing if done on the same day as a visit. 
• Search by Zip Code: Since ease of access to appointments—such as not needing to take a bus—can reduce no-shows, searching for providers or resources within the family’s zip code can increase the likelihood that patients continue care. 

Support Yourself as a Clinician 

Supporting patients facing mental health diagnoses alongside multiple other difficulties and traumas can be challenging for providers. But Dr. Robiou points out that it can be even more rewarding because the need is so great.

“Don’t lose focus or be dissuaded when treatment is not progressing as quickly as you would like,” she shares. “Thanks to our REACH training, we are expediting diagnosis and treatment and potentially eliminating the need for long waitlists and high bills for families.” 

Clinicians interested in supporting systemic change can advocate at the local and state levels to ensure that those setting policy know how healthcare coverage gaps affect patient care and the broader community. For example, preventive mental health care can reduce the need for emergency care and help keep hospitals from being overwhelmed. 

For peer support and advice, PPP alumni can also join the REACH Community Hub, as Dr. Robiou has done. The Hub is a free, professional community created exclusively for PPP alumni to connect, access resources, and support one another. 

RESOURCES

• REACH’s one-day Addressing Trauma in Pediatric Primary Care (ATIPP) course helps PCPs effectively detect, respond, and support child and adolescent patients who have experienced trauma. Join the ATIPP waitlist to be notified about upcoming course dates.
• When dealing with a particularly complex case, clinicians in most states can connect with the Child Psychiatry Access Program in their state for a clinical phone consult and potentially referrals. 
• For prescription discounts, GoodRX and CostPlus Drugs are both helpful resources that patients can use directly.