The federal government has finalized a rule meant to increase access to mental health care for low-income people around the country. But despite the change, in Kentucky there are still barriers for people getting the help they need.

The rule was finalized Tuesday as part of the Mental Health Parity and Addiction Equity Act of 2008. It requires health insurance providers to treat mental health and substance use disorder benefits as they would medical and surgical benefits.

The final rule will affect more than 23 million people enrolled in Medicaid managed care organizations, Medicaid alternative benefit plans and Children’s Health Insurance Program.

Monnica Williams, the director of the Center for Mental Health Disparities at University of Louisville, said generally the insurance reimbursements for mental health care are not as good as they are for other types of medical care. Because of that, she said it’s common for mental health providers to refuse insurance and only accept cash from patients.

“So,  a lot of mental health providers don’t take insurance and so people will have to pay out of pocket,” she said.

Williams said since the Parity law first went into effect in 2008, mental health coverage has improved. But even now, Medicaid compensation for mental health specialists isn’t up to par with other health care providers.

“They’re paying MDs a lot more than they might be paying PhD doctoral level psychologists or other behavioral health specialists who aren’t MDs. So because of that a lot of us opt out of these systems,” Williams said.

The Centers for Medicare and Medicaid Services said under the final rule, plans have to disclose information on mental health and substance use disorder benefits upon request. If the state denies reimbursement or payment for treatment, officials are also required to disclose the reason for denial.

The announcement comes a day after the federal government released a report showing that the expansion of Medicaid can improve access to behavioral health care.

In 2014, about 1.9 million low-income uninsured people with a substance use disorder or mental illness lived in states that had not expanded Medicaid coverage, according to the report.

“If they don’t have insurance then they have to pay out of pocket for those costs, which can be very, very high. Insurance basically makes these treatments more accessible for people who wouldn’t be able to pay out of pocket otherwise,” Williams said.

In Kentucky, former Gov. Steve Beshear implemented the Affordable Care Act and Medicaid expansion under executive order. Expanding Medicaid required the state to broaden its list of health care providers to include a variety of behavioral health specialists. The state also allowed therapists to enroll in Medicaid as independent providers.

Williams said having access to substance use disorder and mental health services means that if someone needs help, there is someone in the community who can provide it. And that there’s a way to pay for the treatment.

“Ideally, your insurance will cover the cost of that and when you actually call to make an appointment, they can get you in rather than saying we’re full or put you on a three month waiting list,” she said.

But in Kentucky, there’s still a shortage of mental health care provides. Williams said a third of the commonwealth’s counties have no psychologists.