2015 APHA Annual Meeting & Expo

Home Events & Meetings Annual Meeting Schedule & Program

Recorded Annual Meeting Presentations (RAMP) are now available for purchase.
Only $90 for presenters, $140 for registered attendees and $200 for non-attendees.

Online Program

333318
Health insurance for children with mental health needs: State mandates, plans and lingering uncertainty


Monday, November 2, 2015 : 8:30 a.m. - 8:50 a.m.

Kathleen Thomas, PhD, Program on Mental Health Services Research, Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC
Kathleen McDermott, School of Public Health, University of North Carolina at Chapel Hill, Chapel HIll, NC
Charlotte Williams, MPH, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC
Neal deJong, MD, General Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC
Christianna Williams, PhD, Cecil G Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC
Joseph Morrissey, PhD, Program on Mental Health Services Research, Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC
Audio (mp3) recording Recorded Presentation (mp4)
Research Objective: The goal of this presentation is to describe variation in state rules regarding health insurance plan features that are important to families raising children with mental health needs. While the Affordable Care Act improves access to insurance, this presentation describes a number of uncertainties that remain.

Study Design: State benchmark plans and related rules as of January 2015 were collected from the Centers for Medicare and Medicaid Services, the National Center for State Legislators, Autism Speaks and USNews. Descriptive statistics characterize plan features and plan offerings within and across states.

Principal Findings: After choice of benchmark plan and modification through rule-making, 18 states allow limits on outpatient mental health benefits and 17 on inpatient mental health benefits. Eight states do not cover habilitative services and 19 cover them but allow limits on benefits. While 40 states mandate coverage of autism, only 25 cover autism in their exchange policies. Moreover, 20 states allow substitution of benefits and 20 others make no provision regarding substitution. States offer a mean of 71(sd72) plans to choose from on their exchanges, with a mean price for a family of 4 of $857(sd139).

Conclusions: State benchmarking and rule-making have led to significant variation in coverage for mental health services across the states. Within each state’s health insurance marketplace, most families face a vast array of plan options. Together these issues make it important and difficult to educate families about health insurance coverage terms, how plans work and how to choose plans.

Learning Areas:

Social and behavioral sciences

Learning Objectives:
Describe federal essential minimum benefits and the authority that states have to choose benchmark plans and related rules to meet essential minimum benefit standards in their health insurance plans Describe the coverage and coverage limits of mental health and habilitative services, including coverage for autism services, and how they vary across state benchmark plans Identify health insurance plan features that can leave families raising children with mental health needs at risk for unexpected out-of-pocket expenditures

Keyword(s): Health Insurance, Child/Adolescent Mental Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the principal investigator of several federally funded grants including two PCORI grants focusing on patient-centered outcomes in child mental health. I have published on access to care for children with mental health needs, and I am currently chair of the Mental Health Section of the American Public Health Association.
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.

Back to: 3064.0: Insurance Choices Facing Families of Children with Mental Health Needs