mental-health-parity-1050
Issue Background

Parity

NAMI continues to work hard to increase Parity for Mental Health and ensure insurance companies do what the law intends. NAMI has also created a great INFOGRAPHIC to explain parity.

Despite legislation designed to create parity in health care plans for mental health services with other physical health services, consumers are consistently finding that true parity does not exist for them.

People who need mental health and substance abuse care have been subjected to pervasive discrimination in health insurance.  Health plans for people with pre-existing mental illness, if they included mental health benefits at all, have historically been more expensive, with limited benefits and significant administrative hurdles to obtaining care.  The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) enacted by Congress in 2008 was designed to remedy the problem and has at least started the work towards true parity in health plans.  The Patient Protection and Affordable Care Act of 2010 (ACA) strengthened parity requirements set forth in MHPAEA by extending federal parity requirements to individual and small group plans.  Mental health and substance abuse use disorder services were mandated as one of ten categories of Essential Health Benefits required for all plans sold through the federal health insurance marketplace or state exchanges.  However, it is well known that efforts to achieve meaningful social change are far from over when laws are passed.  Achieving true equity in accessing mental health and substance use disorder care requires vigilant attention by advocates and public agencies responsible for enforcement. 

A Long Road Ahead - Achieving Parity in Mental Health and Substance Use Care

NAMI published a report called “A Long Road Ahead – Achieving True Parity in Mental Health and Substance Use Care” which reports findings about the true state of parity.  Read NAMI NATIONAL'S REPORTSome of findings include:

1.Consumers and family members report serious problems with finding mental health providers in their health plans.

2.Insurers are denying authorization for mental health care at higher levels than they are for other types of medical care.

3.There appear to be significant barriers to accessing psychiatric medications in health insurance plans.

4.Even when covered, the out of pocket costs of medications may pose a barrier to participating in care.

5.Out of pocket costs may present a greater barrier to inpatient and outpatient mental health care than inpatient or outpatient medical specialty care.

6.When selecting health plans available in State Marketplaces, consumers and family members generally do not have access to information needed to make informed decisions.

Have you had an experience with you or a loved one having any of the difficulties listed above?  If so, we’d like to hear from you.  NAMI will be meeting with the Division of Insurance to help effect change and your individual stories help us to educate the DOI on things they need to do to enforce parity in all health plans.

PLEASE TELL US YOUR STORY HERE

NAMI makes the following policy recommendations:

1.Strong enforcement of MHPAEA is needed.

2.Insurers should be required to publish the clinical criteria they use to approve or deny care.

3.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.

4.The Department of Health and Human Services should require all health plans to provide clear and understandable information about benefits and should be required to make this information easily accessible.

5.Congress and the Executive Branch must work together to decrease out of pocket costs in the ACA for low income consumers.

"Mental health matters!"