Government and Health Care

Questions remain on mental health insurance coverage

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LANSING — When new provisions of the federal Affordable Care Act take effect next year, a number of things could change, but don’t expect a clear answer as to what those changes will be.

Insurers, health administrators and legislators are still trying to iron out details, and without a lot of consensus.

One shift that’s supposed to extend to Michigan — on paper — is called mental health parity.

Under the federal law, employers with fewer than 50 employees will have to cover psychological or psychiatric treatment in the same insurance package that covers physical care. Employers with more than 50 employees won’t have to do the same until 2017.

That equality between mental and physical health care was already supposed to happen, but experts say all too often it doesn’t.

“It’s not unusual for individuals to have limits on the number of visits they can have” for mental health treatment, “where on the physical side they can receive visits as they need,” said Rick Murdock, executive director of the Michigan Association of Health Plans, which represents health insurance companies.

“There’s always the issue of what’s in the benefits package, and what isn’t,” Murdock said.

Mental health parity is already in effect for Medicaid recipients, but those buying on the private insurance market don’t see the same equity, he said.

Advocates and experts say the state is at a tough crossroads with questions of how equality will be enforced, and what will happen if the Legislature doesn’t extend Medicaid coverage to hundreds of thousands of uninsured state residents.

“We desperately need the Medicaid expansion in Michigan,” said Mark Reinstein, president of the Michigan Mental Health Association.

Medicaid expansion and the Affordable Care Act could mean that denying coverage or putting caps on counseling visits would end. Though such disparity was supposed to stop in 2008 when Congress passed the law, Reinstein and others in the psychiatric community say it still exists.

Reinstein said he’s worried because enforcement would require “an incredible expenditure of money,” and current enforcement efforts seem “rather lax.”

That’s why he and other advocates want a state mental health parity law. Michigan is one of seven states that haven’t adopted such laws.

No bills are pending that would require full mental health parity.

“We are lacking the guidance and the measuring stick for evaluating health plans,” said Kathleen Gross, executive director of the Michigan Psychiatric Society.

“Insurance providers all over the state are scrambling” to understand how parity will be implemented and have oversight, she said. “People need guideposts when they’re measuring a plan.

“We’re hoping that the legislation will address parity comprehensively, and not just for autism.”

A bill requiring insurers to cover autism treatment passed last year, but without a provision requiring parity for other mental illnesses.

“The financial piece is where you see the lack of justice,” she added. “Many people are pushed into the public system,” and it “can be particularly difficult to get the treatment you would want for your child.

“We certainly have heard terrible stories of families being bankrupt” when they have to cover a family member with a serious mental illness. There have been a number of cases in which employers take higher co-pay percentages of their employees’ paychecks for mental health care.

“You might have to pay 10, 15, 20 percent for your physical care,” Gross said. “But if you have to pay 50 percent for hospitalization for a family member who is acutely mentally ill, that can run up to hundreds of thousands of dollars.

“It doesn’t take much these days to tip a family into a medical cost bankruptcy,” she said.

Meanwhile, the Legislature is debating whether to pass the federally funded Medicaid expansion.

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