Online Program

Enforcing Mental Health Parity Through the ACA - A Study of Mental Health Benefits by State and a Roadmap for Change

Monday, November 2, 2015

Rachel Meadows, MPA, PolicyLab The Children’s Hospital of Philadelphia, Philadelphia, PA
This abstract is intended for a lay audience. In 2008, Congress enacted the Mental Health Parity and Addiction Equity Act (MHPAEA), which required group health plans to offer mental health (MH) and substance use (SU) benefits at parity with surgical/medical benefits, with respect to financial requirements and treatment limitations. MHPAEA, however, did not require insurance plans to cover mental health services; the parity mandate only applied to insurance providers that chose to offer MH/SU benefits in addition to medical/surgical coverage. This loophole resulted in many insurance plans dropping their MH/SU benefits to avoid compliance with MHPAEA. In 2010, the Affordable Care Act (ACA) required that any qualified health plan (QHP) sold in the marketplaces must cover MH/SU treatment services as part of the essential health benefits (EHB). Together, the MHPAEA and the ACA create an enforceable coverage-parity mandate for MH/SU benefits; states have the primary responsibility of enforcing both laws. However, to date there has been little oversight or enforcement of either the MHPAEA or the mental health component of the ACA. Furthermore, because the EHB were not defined through regulation, each state defines EHB standards, including mental health, through a benchmark plan model, which has resulted in broad variability across states in how plans define and limit their benefits. Our analysis studied MH/SU benefits under each benchmark plan identifying inclusions and exclusions by state. We propose a novel enforcement strategy for the federal government and states to expand MH/SU benefits and ultimately improve MH/SU outcomes.

Learning Areas:

Public health or related laws, regulations, standards, or guidelines
Public health or related public policy

Learning Objectives:
Describe how the Mental Health Parity and Addiction Equity Act (MHPAEA) and the Affordable Care Act (ACA) expanded mental health benefits. Identify how there is broad variability from state to state in how plans define and limit their mental health benefits under the ACA’s Essential Health Benefits. Discuss how current enforcement of MHPAEA is ineffective. Describe how MHPAEA enforcement can be strengthened by targeting enforcement on plans sold in public exchanges

Keyword(s): Mental Health, Affordable Care Act

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Communications and policy associate at PolicyLab at The Children’s Hospital of Philadelphia (CHOP) and a member of the PolicyLab leadership team. I provide strategic policy and planning support for research projects throughout PolicyLab, and oversee all of PolicyLab’s external communications, including a comprehensive redesign of PolicyLab’s web site. I am focused on understanding the larger policy environment and using both traditional media and social media to ensure that PolicyLab research informs program and policy decisions.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.