Why are denials still happening?
Authored by: The BD SUMHAC Team
Looking Ahead: From Policy Change to People-Powered Access
In 2022, when BD SUMHAC began this work, we were trying to answer a basic but urgent question: Why are people with bleeding disorders being denied access to inpatient and residential mental health and substance use treatment?
At first, we assumed the answer would be found in federal or state regulations. But through years of advocacy, policy analysis, and real-world casework, we learned something different and far more complicated.
There are no widespread federal or state laws that prohibit people with bleeding disorders from accessing behavioral health treatment. In fact, people with bleeding disorders are protected under federal disability laws, including the Americans with Disabilities Act and Section 504 of the Rehabilitation Act, which prohibit discrimination on the basis of disability.
The real barrier lies elsewhere.
Behavioral health facilities are granted significant discretion in determining whether they can safely meet an individual’s medical needs. When a facility claims that a person’s bleeding disorder is “too medically complex” to manage, the denial is often framed not as discrimination, but as a safety concern. Too often, these decisions are made without a true understanding of what it takes to manage a bleeding disorder.
Fear, unfamiliarity, stigma, and misunderstanding remain far too common.
BD SUMHAC has made important progress on the policy front. We helped strengthen Section 504 regulations to require individualized assessments, worked with the American Society of Addiction Medicine to clarify in its Fourth Edition Criteria that people who require infusion medication do not automatically require the highest level of care, and supported MASAC recommendations affirming that people with stable, well-managed bleeding disorders should not be excluded from inpatient or residential mental health or substance use treatment.
These wins matter. But they are not enough.
We now know that policy alone will not solve this access problem. Real change requires equipping community members and providers with the knowledge, tools, and confidence to educate facilities, advocate during referrals, and respond effectively to denials.
That understanding is shaping BD SUMHAC’s work in 2026.
As we look ahead, our focus is shifting toward education, empowerment, individual advocacy, and sustainability. This means helping people engage their treatment teams early, often, and honestly, and ensuring they are prepared long before a crisis occurs.
Stay tuned for the key initiatives guiding this next chapter.