Mental health is a major concern among Americans. We’ve seen horrible tragedies like the Sandy Hook, Conn. school shooting and the Aurora, Colo. movie theater shooting where mental health issues clearly played a role.
Coverage for mental health treatment still has a long way to go. According to the National Institute for Mental Health, more than 25 percent of U.S. adults suffer from a form of mental health problem in any given year. However, fewer than half get medical treatment.
From a medical standpoint, dealing with mental health long has been a tough problem. Experts point to high cost, lack of access to treatment and service, and social stigma. Many patients also suffer from revolving door syndrome, where they get better for a while, only to end up back in the system after some time.
The Affordable Care Act (ACA) and the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 aimed to address the situation. But gaps in coverage might still exist even after both laws are fully implemented.
Under the MHPAEA, companies that employ 50 or more people and supply health insurance must include an equal level of mental and physical health coverage. The law prohibits different co-payments, deductibles, and visit restrictions.
Ideally, these changes would benefit 140 million Americans. However, the law is not always enforced and some people do not receive equal coverage. Also, employers are not required to provide mental health coverage. They also can exclude specific mental disorders from coverage. The Parity Act also does not apply to small businesses and individual health plans.
The Affordable Care Act will establish health insurance exchanges, changing the way insurance is purchased. Small businesses and individuals can enroll in this new marketplace starting Oct. 1, 2013. Coverage begins Jan. 1, 2014.
Health insurance exchanges are designed to make health insurance more affordable and easier to purchase. All health plans sold through the exchanges are required to include mental health coverage as part of 10 essential health benefits as stipulated by the new law. In addition, the coverage provided should comply with the parity law that applies to large employers. Even if you purchase your plans outside of the exchange, the same rules will still apply. All individual and small group plans purchased starting in 2014 will include mental health benefits with the same level of coverage as for medical and surgical treatment. However, the details are still being hammered out.
In 2014, individuals newly eligible for Medicaid coverage will receive mental health benefits contiguous with other medical or surgical treatment. However, most states already offer mental health benefits for existing Medicaid patients that are more robust than the coverage currently offered by commercial health insurers. In that case, those who are newly eligible for Medicaid coverage might be offered inferior mental health benefits than existing Medicaid clients since the new benefits will be on par with private insurance purchased by small businesses right now. States might find it difficult to maintain different Medicaid programs for current beneficiaries and the newly eligible. Only time will tell if most states will offer all Medicaid clients the better deal.