Federal Parity and Spending for Mental Illness

Abstract

BACKGROUND: Families of children with mental health conditions face heavy economic burdens. One of the objectives of the Mental Health Parity and Addiction Equity Act (MHPAEA) is to reduce the financial burden for those with intensive mental health service needs. Few researchers to date have examined MHPAEA’s effects on children with mental health conditions and those with particularly high mental health expenditures. METHODS: A difference-in-differences approach was used to compare commercially insured children ages 3 to 18 years (in 2008) who were continuously enrolled in plans newly subject to parity under MHPAEA to children continuously enrolled in plans never subject to parity. Data included inpatient, outpatient, and pharmaceutical claims for 2008–2012 from 3 national commercial insurers. We examined annual mental health service use and spending outcomes. RESULTS: Among children with mental health conditions who were enrolled in plans subject to parity, parity was associated with $140 (95% confidence interval: −$196 to −$84) lower average annual out-of-pocket (OOP) mental health spending than expected given changes in the comparison group. Among children who were ≥85th percentile in total mental health spending, parity was associated with $234 (−$391 to −$76) lower average annual OOP mental health spending. CONCLUSIONS: MHPAEA was associated with increased financial protection on average for children with mental health conditions and among those at the higher end of the spending distribution. However, estimated reductions in OOP spending were likely too modest to have substantially reduced financial burden on families of children with particularly high mental health expenditures.

Parent Perspectives on Addressing Emotional Health for Children and Young Adults With Juvenile Myositis

“…For example, most child psychiatrists in the US cluster in affluent, metropolitan areas, with 70% of counties having none (30). While caring for children with comorbid emotional and medical needs is expensive at the family and health systems levels, policy changes targeting patients with high health care utilization can lessen associated financial burdens (31)(32)(33)(34)(35). Fragmentation of care pres ents another barrier, but structured care coordination systems can improve health outcomes and minimize costly inpatient and emergency department visits for children with complex psychosocial needs (36).…”

Health Care Spending by Enrollees With Substance Use and Mental Health Disorders in High-Deductible Health Plans vs Traditional Plans

“…We identified plan enrollees with at least 2 uniquely dated SU/MH claims using a standard set of International Classification of Diseases, Ninth Revision codes and hand verifying a Centers for Medicare & Medicaid Services International Statistical Classification of Diseases and Related Health Problems, Tenth Revision crosswalk. Enrollees were classified as having 1 or more disorders: opioid use, alcohol use, other substance use, anxiety or posttraumatic stress, adjustment, depressive, schizophrenia, bipolar, or other mental health disorders.…”

Developing a Structure of Essential Services for a Child and Adolescent Mental Health System

“…This legislation offered great hope that by equating mental health and medical/surgical services that the systemic improvements enacted for medical care would be replicated for mental health care. Consequent to the law, utilization was not substantially changed, although access to services for children with autistic spectrum disorder increased, and individuals had lower out‐of‐pocket costs 61,62 . Unfortunately, the expectation of parity of benefits generally has not been fulfilled, and the two major branches of health care remained functionally divided 63 .…”

“…Consequent to the law, utilization was not substantially changed, although access to services for children with autistic spectrum disorder increased, and individuals had lower out-of-pocket costs. 61,62 Unfortunately, the expectation of parity of benefits generally has not been fulfilled, and the two major branches of health care remained functionally divided. 63 During the past decade, however, there has been an increased call for integration of medical and behavioral health services, at least at the practice level.…”