Medicaid mental care for seniors,
others may soon match care for physical health
Government had previously ordered
parity by private managed care insurers, now want rule to activate in
Jenny Gold, Kaiser Health News
7, 2015 - A federal law that passed in 2008 was supposed to ensure that
when patients had insurance benefits for mental health and addiction
treatment, the coverage was on par with what they received for medical
and surgical care. But until now, the government had only spelled out
how the law applied to commercial plans.
That changed Monday, when federal
long-awaited rule proposing how the parity law should also
protect low-income Americans insured through the government’s Medicaid
managed care and the Children’s Health Insurance Program (CHIP) plans.
The proposed regulation is similar
to one released in November 2013 for private insurers.
“Whether private insurance,
Medicaid, or CHIP, all Americans deserve access to quality mental health
services and substance use disorder services,” said Vikki Wachino,
acting director at the Center for Medicaid and CHIP Services.
Medicaid and CHIP programs are
funded jointly by the federal and state governments.
Even if the state has carved out
some benefits under a separate behavioral health plan, patients would be
protected under the rule. Medicare patients are generally not affected
by the regulation, nor are those in Medicaid fee-for-service plans . But
the rule does affect the majority of the 70 million people on Medicaid
who are in managed care plans, and the 8 million children covered by
Insurers, advocates and the general
public will have a chance to comment on the proposed rule. The
government will then release a final version.
The proposal would mean that plans
no longer could have hard limits on coverage such as a certain number of
mental health visits in a year. And if a patient were to be denied
treatment for a mental health or substance use disorder, the insurer
would have to explain why.
The regulation has been
a long time coming,
says former Rhode Island congressman Patrick Kennedy, lead author of the
Mental Health Parity and Addiction Act, which passed two years before
the Affordable Care Act (also known as Obamacare).
“Even if this rule goes forward,
it’s going to be at least another 18 months to implement it. We’re going
to be a decade … between when the law was passed and when it’s going to
be effective,” said Kennedy. “It’s very emblematic of what we’ve always
faced in mental health. We’re always secondary and an afterthought in
Kennedy and other advocates across
the country say commercial insurance plans have been
slow to implement
the parity law, even though they have had a final rule for
more than a year. Patients
discrimination in their mental health and substance abuse
care, Kennedy said, and the federal government has not aggressively
enforced the law.
“We have a lot of lessons learned
already on the failure of parity to be enforced in commercial plans. We
definitely will be carrying over those same problems [into Medicaid
plans] if we don’t correct them in time,” he said.
The responsibility for enforcing
the new regulation will fall first to state Medicaid agencies. Matt Salo,
executive director of the National Association of State Medicaid
Directors, said the rule is a welcome development.
“Medicaid has quietly become the
largest payer of mental health services in the country,” Salo said.
“Medicaid directors are hopeful
that parity ultimately helps to level the playing field, which would
allow more people to get the care they need at the right time, and
ultimately reduce future reliance on Medicaid.”
In the short term, the rule is
expected to cost state Medicaid programs $150 million in additional
behavioral health costs.
“Because of decades of insufficient
investments from other payers, approximately 30 percent of all Medicaid
dollars are spent on individuals with behavioral health needs. These
regulations will lead to increased coverage of - and therefore spending
on - behavioral health services for Medicaid beneficiaries in managed
care or other capitated care models,” Salo explained.
Mario Molina, CEO of Molina
Healthcare, a large Medicaid health plan based in Long Beach, Calif.,
said he applauds the government’s plan to have the parity law apply to
Medicaid plans. “It’s a great idea,” he said.
Even with parity provisions,
however, Molina said he worries about the shortage of mental health
providers in Medicaid. “It won’t impact the number of providers, but it
will increase demand for them,” he said.
the director of health law and policy at substance abuse and addiction
center CASAColumbia, worries that access to care will make parity
difficult to achieve in practice.
The parity rule “will not be enough
to overcome all of the barriers that patients face in accessing care,
including an insufficient number of in-network providers,” she said.
Under the proposed rule, however, plans that allow access to
out-of-network providers for physical health issues must provide access
for mental health as well, she said.
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