The self-pay market for child mental health care potentially exacerbates inequities in access to care by burdening low-income families with high costs. Incentivizing mental health providers to participate in insurance for larger portions of their patient panels, for example, by increasing reimbursement rates and reducing paperwork, may help improve equitable access to mental health care. To the extent that reimbursement rates drive insurance acceptance, the frequency of self-pay mental health visits suggests that mental health services are underreimbursed relative to their benefit to patients and families.