Christen Bowman
Western Washington University
Policy Brief: Mental Health Parity
Insurance Companies are major stakeholders on the topic of mental health parity. Insurance
companies are the intended audience of this policy brief.
Policy Brief: Mental Health Parity
Summary
The Affordable Care Act (ACA) and the Mental Health Parity and Addiction Equity Act of 2008
(MHPAEA) have transformed mental health insurance coverage in many positive ways. These
laws have made great strides towards equal insurance coverage for the mentally ill. Regardless,
patients continue to experience denial of mental health benefits. Additionally, patients have a
difficult time finding mental health providers and receiving access to care in a timely fashion.
Though the ACA and MHPAEA have passed, gaps in coverage and access to care remain.
Background
According to Goodell (2015) the MHPAEA does not require plans to offer benefits for mental
health and substance use disorders, nor does it require specific conditions to be covered.
(Whats the law? para 3) The ACA picked up where the MHPAEA left off. Honberg, Diehl, &
Douglas (2015) state that the ACA strengthened parity requirements set forth in MHPAEA by
extending federal parity requirements to individual and small group plans. Further, mental health
and substance use disorder services were required for all plans sold though the federal health
insurance marketplace, or state exchanges (p. 1). These laws work together to close the gaps in
coverage but insured people with mental illness continue to face challenges with the system.
Gaps in Coverage:
Even though the ACA and the MHPAEA close many of the gaps in coverage, one policy analysis
revealed that coverage remains discriminatory toward the mentally ill population. Goplerud
(2013) stated our analysis indicate[s] that plans frequently employ [non-quantitative treatment
limitations (e.g. day limits, visit limits)] for behavioral health conditions that are more restrictive
than those used for other medical/surgical conditions. (p.x) Insurance companies may deny
coverage deeming it as not medically necessary. (Honberg, R., Diehl, S. & Douglas, D., 2015,
p.4) Additionally, patients may face high out of pocket costs for prescription drugs, high co-pays,
deductibles and other financial barriers that may deter them from accessing their care. Goplerud
(2013) goes on to describe a year-by-year analyses from 2009 to 2011 confirm[s] a dramatic
decline in the use of more restrictive coinsurance, copays and other financial requirements for
[mental health/substance abuse disorder], but a minority of plans continued in 2011 to impose
higher costsharing, especially for in-network outpatient MH/SUD treatment (p. viii)
Access to Care:
Lastly, access to mental health care is a major barrier for mental health patients. In a survey
conducted by a nonprofit mental health advocate group, results found that patients often had
difficulty finding mental health providers in their insurance plan network. Honberg, Diehl, &
Douglas (2015) say that most likely, these barriers are attributable both to severe shortages in
qualified mental health professionals in most parts of the country and to inadequate provider
networks maintained by health insurance plans (p. 3).
Recommendations
Honberg, Diehl, & Douglas (2015) recommend:
Insurers should be required to publish the clinical criteria they use to approve or deny care
Health plans should be required to publish accurate lists of providers, including mental
health providers, participating in plan networks and to update those lists regularly.
Congress and the Administration must work together to decrease out of pocket costs in the
ACA for low income consumers (p.13-14).
References
Goodell, S., (2015). Health Policy Brief: Enforcing Mental Health Parity, Health Affairs.
Retrieved from http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=147
Goplerud E., (2013). Consistency of Large Employer and Group Health Plan Benefits with
Requirements of the Paul Wellstone and Pete Domenici Mental Health Parity and
Addiction Equity Act of 2008, U.S. department of health and human services assistant
secretary for planning and evaluation office of disability, aging and long-term care
policy. p. X - A-71. Retrieved from
http://www.dol.gov/ebsa/pdf/hhswellstonedomenicimhpaealargeemployerandghpbconsist
ency.pdf
Honberg, R., Diehl, S. & Douglas, D., (2015). A Long Road Ahead - Achieving True Parity in
Mental Health and Substance Use Care, National Alliance on Mental Illness (NAMI). p.
1-21 Retrived from http://www.nami.org/About-NAMI/Publications-Reports/PublicPolicy-Reports/A-Long-Road-Ahead/2015-ALongRoadAhead.pdf
