Mental Health Parity Final Powerpoint.ppt · Rockefeller Center at Dartmouth College Policy Research Shop A Center for Public Policy and the Social Sciences Mental Health and Substance

Rockefeller Center at Dartmouth College Policy Research ShopA Center for Public Policy and the Social Sciences

Mental Health and Substance Abuse Insurance Parity

Current status of mental health problems in New Hampshire, effects of new federal legislation and other states’ experiences

Prepared by: Karen Doster, Alicia Modeen, Jennifer Murray, and Anya Perret

April 23, 2009

This report was written by undergraduate students at Dartmouth College under the direction of professors in the Rockefeller Center. Support for the Policy Research Shop is provided by the Ford Foundation.


In This Presentation…I. Mental Health and Substance Abuse in New HampshireI. Mental Health and Substance Abuse in New Hampshire

i. Prevalence

ii. Costs

iii. Federal Legislationiii. Federal Legislation

II. Mental Health Insurance Coverage in New Hampshirei. Employer Coverage and Parity

ii Medicare and Parityii. Medicare and Parity

iii. Medicaid and Parity

III. State Mental Health and Substance Abuse Parityi V ti. Vermont

ii. Other States

IV. Conclusions and Recommendations


Mental Health and Substance Abuse in New HampshireAbuse in New Hampshire


In the U.S. Adult Population…

Major Depressive Disorder : 7%

Physical Illnesses

Heart Disease: 11%

Mental Illnesses

Social Phobias : 7%

Post Traumatic Stress Disorder: 4%

Generalized Anxiety Disorder : 3%

Diabetes: 8%

Cancer: 7%

Generalized Anxiety Disorder : 3%

Bipolar Disorder: 3% Health Care Spending

MentalPhysical

S Th N b C M l Di d i A i 2008 N i l I i f M l H l h 16Source: The Numbers Count: Mental Disorders in America. 2008. National Insitute of Mental Health. 16 Apr. 2009 <http://www.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-in-america/index.shtml>.Pleis JR, Lethbridge-Çejku M. Summary health statistics for U.S. adults: National Health Interview Survey, 2006. National Center for Health Statistics. Vital Health Stat 10(235). 2007.


Illicit Drugs

Substance Abuse in New Hampshireg

Used by 9% of adults in 2004 (8% in U.S.)

25.9% of NH high school students reported “current” use of marijuana.

Alcohol

Moderate use by 59% of adults in 2004

Heavy (more than 1-2 drinks) use by 16% 20% of NH drug users Heavy use by 24% of those 12+

20% of NH drug users who have a self-

proclaimed need for treatment aren’t Source: Stephen, John A., Mary Ann Cooney, and Jose Thier Montero. "Working Together to treatment aren t

getting it.

Source: Stephen, John A., Mary Ann Cooney, and Jose Thier Montero. Working Together to Assure a Healthy Public: The State of New Hampshire's Health." NH DHHS (2007).

Source: United States. White House Office of National Drug Control Policy. ONDCP Drug Policy Information Clearinghouse. State of New Hampshire: Profile of Drug Indicators. Rockville, Maryland, 2007.


Mental healthcare in New Hampshire

• National Alliance on Mental Illness State Report Card (2009): grade of CReport Card (2009): grade of C– Shortage of psychiatric beds

L k f ff d bl h i f ll ill– Lack of affordable housing for mentally ill

– Lack of jail diversion programs

Source: 1.State Report Cards: New Hampshire. National Alliance on Mental Illness. 2009: (1). <http://www nami org/gtsTemplate09 cfm?Section=Grading the States 2009&Template=/c<http://www.nami.org/gtsTemplate09.cfm?Section=Grading_the_States_2009&Template=/contentmanagement/contentdisplay.cfm&ContentID=74903>.


Federal Legislation• H.R. 1424 (Paul Wellstone Mental Health Parity and

Addiction Equity Act of 2008)

• Mental health parity by January 1, 2010

• Small business exemption

• 0.4% increase in premiums for group health insurance (CBO estimate)

• H.R. 6331 (Parity for Medicare)• Mental health parity for Medicare recipientsSource: 1.H.R. 1424 <http://www.govtrack.us/congress/billtext.xpd?bill=h110-1424>.2.Congressional Budget Office. H.R. 1424. November 21, 2007; 1.3.H.R. 6331 <http://www.govtrack.us/congress/bill.xpd?bill=h110-6331>.


Impact on New Hampshire

• Prevalence of small businesses

• Insurance companies not mandated to • Insurance companies not mandated to provide mental health care benefits

• Insurance companies may seek exemption • Insurance companies may seek exemption in the face of exorbitant costs

R l i b O b • Regulations by October 3, 2009Source:1.Daly, Rich. Parity Law’s Next Hurdle: Working out Fine Print. Psychiatric News. 43.22 (2008): 1. <http://pn.psychiatryonline.org/cgi/content/full/43/22/1>.2.Clay, Rebecca A. Parity: What does the new law mean? SAMSHA News 16.6 (2008) <http://www.samhsa.gov/SAMHSAnewsLetter/Volume_16_Number_6/ParityImpactFull.aspx>.3.U.S. Small Business Administration. Small Business Profile: New Hampshire. Washington: Government Printing Office, 2007; 1.


Mental Health Insurance Coverage in New Hampshirein New Hampshire


NH Health Insurance Coverage

At a Glance


Employer Coverage and Parity

• 65% of NH Residents

• Employer Coverage Gapsp y g p– Small businesses not covered

– Substance abuse coverage is optionalSubstance abuse coverage is optional

• Example: Harvard Pilgrim Health Care

C l i P it l i l ti ill h • Conclusion: Parity legislation will have a minimal impact on NH employers1

Source: 1. Attila Cseh (2008) "Labor Market Consequences of State Mental Health Parity Mandates," Forum for Health Economics & Policy: Vol. 11: Iss. 2 (Health Care Reform), Article 5.http://www.bepress.com/fhep/11/2/5


J l 8 M di I t f

Medicare: Overview• July 2008, Medicare Improvements for

Patients and Providers Act of 2008 (H.R. 6331) 6331). – Mental health parity in Medicare by 2014

• Co-payment reduction from 50% to 20%

• Is Substance Abuse Treatment Covered1?– Yes, if:

• 1) Medicare-participating provider or facility• 2) Doctor states services are medically necessary;• 3) Your Doctor sets up your plan of treatment3) Your Doctor sets up your plan of treatment

Source: 1) http://www.medicareinteractive.org/page2.php?topic=counselor&page=script&slide_id=925


Medicaid: Overview

• 6% NH residents

• 2% cuts to NH reimbursement December 2008• 2% cuts to NH reimbursement December 2008

• Example: West Central Behavioral Health Clinic1

72% of patients on Medicaid1– 72% of patients on Medicaid1

– Very limited funding

C l i P it l i l ti ill h i i l • Conclusion: Parity legislation will have a minimal impact on Medicaid in NH

Source: 1) Suellen Griffin, Executive Director of West Central Behavioral Health, personal communication, 3/10/09.


• NHHK administers CHIP (0 18 yrs)1

CHIP and NH Healthy Kids• NHHK administers CHIP (0 18 yrs)1

• All beneficiaries have MH and substance abuse (fee-for-service)( )– Max. 15 days/year for inpatient services– Max. 20 days/year for inpatient substance abuse

servicesservices– Max. 20 days/year for outpatient services

• Feb 4, 2009 H.R. 2– Mental health Parity in CHIP– 4 million+ children (USA) will be eligible for CHIP

coverage2gSource: 1)NH Healthy Kids. 11 Mar. 2009 <http://www.nhhealthykids.com/>. 2)American Psychiatric Association. News Release. Feb. 4, 2009. Release No. 09-09; 1.


Figure 1. Population of Children in NH <=18 Privately Insured

Figure 2. Mental Illness in the Medicaid Population in NH <=18 y

with an Indication of Mental Health Illness

p(2005 Medicaid Incurred Data)

Source: Tappin, Ryan, and Steve Norton. Children's Mental Health In New Hampshire. Rep. Sept. 2007. New Hampshire Center for Public Policy Studies. 12 Feb. 2009 <http://www.nhpolicy.org/report.php?report=11>.


Problems with Medicaid and Parit

• No substance abuse coverage for adult Medicaid enrollees

Parity

enrollees

– 1/5 Medicaid hospital stays is attributable to substance abuse1substance abuse1

• Aging population may increase NH Medicaid enrollmentenrollment

Source:1. "New Hampshire: Health Insurance Coverage of the Total p g fPopulation, states (2006 2007), U.S. (2007)." State Health Facts. 10 Nov. 2008. The Kaiser Family Foundation. 10 Nov. 2008 <http://www.statehealthfacts.org/profileind.jsp?ind=125&cat=3&rgn=31>.


S M l H l h d S b State Mental Health and Substance Abuse Parity


Parity Legislation: State by State

• Full – 4Maryland, Vermont, Connecticut, Oregon

• Partial - 3di k i llIndiana, Kentucky, Maine exempt small

businesses

• Limited – 25 (includes New Hampshire)• Limited – 25 (includes New Hampshire)Often only cover Severe Mental Illness, exempt small/medium businesses, no substance abuse. / ,

• Recommendation/No Law - 18


Case Study: Vermont after Parity

• Employers did not drop or lessen coverage

• Access to substance abuse treatment was more limited

• Spending for covered MH/SA services declined

• Consumers paid less for covered MH/SA treatment

• Managed care helped control costs

f i l i l l• Awareness of parity was relatively low


Other Case Studies – Minimal Data• Maryland, Connecticut Maryland, Connecticut

- Minimal reported changes (but lack of analysis)

• Labor Market- Parity did not negatively impact available jobs

- Parity did not decrease wages

S i id R t• Suicide Rates

- Decreased suicide rates in workers aged 30-64


Case Study Lessons• Parity laws often exempt small businesses; small

b l d hbusinesses most common employer around the country and in NH

• All current parity legislation allows providers (insurance companies) to determine whether MH/SA treatments are medically necessary MH/SA treatments are medically necessary

• So, parity rarely increased costs and the costs never pro ed prohibiti e but parit does not usuall result proved prohibitive, but parity does not usually result in greatly increased MH/SA treatments.


ConclusionsI. Understanding the limits of mental health insurance parity.

i. Small businesses, Medicaid, self-insured, uninsured

II. Costs and benefits of investing nowgi. Government spending unpopular in current economic climate

ii. $7.46 in societal costs saved for every $1.00 invested in mental health and substance abuse, including economic productivity

III. Importance of including substance abuse in parity

IV. Effects of new federal legislation still unclear


Recommendations

I. Expanding Medicaid substance abuse coverage

II. Maintaining funding of community mental health centers

III. Addressing the needs of the aging community

IV I l i d i iIV. Implementing an education campaignI. To reduce stigmatization of mental illnesses & seeking treatment

II. To familiarize NH residents with new parity regulations and i th i lik lih d t k t t tincrease their likelihood to seek necessary treatment


Thank You!Thank You!

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Mental Health Parity Final Powerpoint.ppt · Rockefeller Center at Dartmouth College Policy Research Shop A Center for Public Policy and the Social Sciences Mental Health and Substance