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Katiri Zuluaga

Manager, State Initiatives

New Report Shows Mental Health/SUD Parity At Risk

June 20, 2018 | ACA | Parity | Comments
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The National Alliance on Mental Illness (NAMI) recently released a report “Mental Health Parity at Risk” highlighting disparities in health coverage for behavioral health services. Parity ensures that patients have access to health plans that cover mental health and substance use disorder treatment, in addition to medical/surgical services, and that they are not charged more for using such services. The report finds that parity was very weak prior to the passage of the Affordable Care Act’s (ACA) consumer protections, which limited consumers’ access to treatment. The report underscores how current efforts to weaken the individual insurance market could mean returning to a time when Americans with behavioral health conditions could be denied coverage or offered coverage that excludes services they need.

The Mental Health Parity and Addiction Equity Act, which passed into federal law in 2008, requires that coverage limitations on mental health and substance use disorder (MH/SUD) benefits cannot be more restrictive than they are for medical or surgical benefits. The ACA made MH/SUD services an essential health benefit (EHB), requiring not only that health insurance plans include MH/SUD services, but that these services also be covered at parity with other health services. The EHB requirement applies to all health plans sold on the individual insurance marketplace.

NAMI’s new report, Mental Health Parity at Risk, looks at the barriers and gaps in mental health and substance use disorder coverage in the individual health insurance market prior to the ACA and finds that:

  • Twenty-eight states did not require individual market insurance plans to cover or even offer mental health services;
  • Insurers routinely denied coverage to people with preexisting mental health or substance use conditions by screening applicants and offering coverage that excluded the services they needed;
  • Insurers penalized people with a history of mental health or substance use conditions by imposing a 20, or even 50, percent increase in premiums while also excluding needed mental health and substance use services;
  • Insurers offered superficial coverage that did not meet needs by imposing limitations like lifetime caps, limits on outpatient visits, limits on inpatient days covered and exclusions of mental health medications; and
  • Insurers actively created barriers and limited access for people trying to get mental health and substance use treatment through aggressive cost-sharing and lengthy prior authorization procedures.

Unfortunately, the Administration has enacted changes that would open the door to health plans that closely mirror those offered prior to the ACA. The Administration’s association health plan (AHP) rule and pending rule on short-term health plans would weaken protections for preexisting conditions like mental illness and SUDs and remove the EHB requirement for health plans to include mental health and substance use disorder treatment.

Read the full NAMI report here.