It’s Final: Parity in Medicaid

Centers for Medicare and Medicare Services (CMS) recently finalized long awaited rules for mental and behavioral health parity in Medicaid, marking a significant milestone for access to mental health care. Congress passed the Mental Health Parity and Addiction Equity Act (MHPAEA) in 2008, setting new guidelines for patients’ access to mental and behavioral health services. Rules for commercial insurance plans were finalized in 2013 and now comparable rules have been finalized for Medicaid.

We commend CMS for finalizing rules that provide an important step forward for low-income families that need mental health treatment or substance use treatment in order to succeed in work or school and to be healthy parents to their young children. Access to mental and behavioral health services are critical supports for many low-income Americans, including mothers with maternal depression.

Depression is widespread among poor and low-income mothers, including mothers with young children. One in nine poor infants lives with a other experiencing severe depression and more than half live with a mother experiencing some level of depressive symptoms. While depression is highly treatable, many low-income mothers do not receive treatment – even for very severe levels of depression. Indeed, more than one-third of low-income mothers with major depressive disorder get no treatment at all. Unfortunately untreated maternal depression is damaging to children, particularly young children, placing at risk their safety and cognitive and behavioral development. In addition to the health complications caused by depression, such as frequently occurring with comorbid medical conditions, depression is also association with unemployment or underemployment.

For all these reasons, the new rules for parity in Medicaid stand to make a significant difference in the lives of low-income mothers and families. CLASP is particularly pleased to see the following elements included in the final rule:

  • Medicaid plans will not be able to apply different treatment limits to mental or behavioral health than are applied to medical/surgical treatments. For example, if a plan allows an unlimited number of doctor visits based on medical necessity the plan must also allow unlimited number of mental health visits as deemed medically necessary.
  • All Medicaid enrollees will benefit from the parity rules, regardless of whether they receive Medicaid through traditional “fee-for-service” or a Managed Care Organization (MCO). If a state uses MCOs to provide Medicaid benefits, all MCOs must ensure compliance with the new parity rules regardless of whether mental health benefits are administered separate (often called a “carve out”) .
  • MCOs must share, upon request, their medical necessity criteria with any enrollee, potential enrollee, or contracting provider. Furthermore, MCOs must make available the reason for any denial of reimbursement or payment for services for mental health/substance use disorder. These two provisions are critical to the first item listed above, ensuring that mental health/substance use disorder benefits are available with no more restrictive criteria than comparable medical/surgical benefits.

States have until October 2017 to comply with the new rules. Given the potential for positive impact these rules have on low-income families, we urge states to consider a speedier implementation timeline.