Changes in Coverage Threaten Mental Health Parity

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Stigma is all-powerful in the lives of children with mental illness. It informs decision-making for parents, insurance carriers, and legislatures. When mental illness is attributed to moral failings or poor parenting, it's undervalued both figuratively and in actual dollars.

For instance, this September, news emerged that Minnesota's largest insurance carrier, Blue Cross and Blue Shield of Minnesota (BCBS), is cutting payments to mental health providers by double digits. The cuts are the result of a survey that showed Minnesota's individual therapy costs have exceeded the national average for the last two years. Mental health professionals immediately responded with concern, including protesting this Thursday at the BCBS headquarters in Eagan, MN. Providers are concerned that cuts to their reimbursements will lead to a decrease in quality of, and access to, mental health care. BCBS is also the largest provider of Medicaid in Minnesota, meaning disabled individuals, those with low incomes, and children will be hardest hit.

Access to healthcare has been a divisive national conversation of late. In the many proposals to change healthcare coverage laws, mental health and addiction services are often the biggest victims. This is despite the 2008 Mental Health Parity and Addiction Equity Act (MHPAEA) that requires health insurers to treat mental health and addiction coverage exactly as they would medical and surgical care. The Affordable Care Act (ACA) further expanded on this. That means that, less than 10 years ago, adults and children with mental illness could not expect to have equitable coverage of mental health care, if they had coverage at all. Those in Minnesota are concerned that decisions like that of BCBS of Minnesota violate that parity even today.

Parents of children with mental illnesses have a huge stake in this conversation. My ten-year-old son's hospitalization and partial hospitalization last year cost, in total, around $120,000. Even with insurance coverage, more than $10,000 came out of pocket. That does not include post-hospitalization bills for therapy, psychiatry appointments, and monthly medications. My son has attention-deficit/hyperactivity disorder (ADHD), which the CDC estimates affects 11 percent of children 4-17 years old. For children ages two to five, ADHD diagnoses have increased by 50 percent in the last few years. My son's disruptive mood dysregulation disorder (DMDD) lead to the hospitalization, and mood disorders are also not rare in children.

Despite the rising need for it, prevention is often not a priority for children with mental illnesses. Families, insurance companies, and communities arguably suffer more long-term financial and emotional costs from a child's hospitalization than they do for therapies, medications, school interventions, and community resources that prevent them. Theoretically, these same measures could also prevent future calamities like jail or prison time. This is what makes cuts in insurance coverage potentially so damaging. Weekly therapy appointments at $110 per hour for a year would cost $5,720. One day in a psychiatric hospital in the United States can cost $1100 - $2800 per day, with the average stay estimated to be eight days.

It's imperative that our country continues to push for mental health parity in our healthcare debates. Poor outcomes for some adults with mental illness or addiction can be prevented if we start treatment in childhood. In a Minnesota Public Radio piece on managing addiction, they pointed out that the cause of addiction is not the drugs themselves. Addiction sprouts from potential lifetimes of lack of access to resources, poor social networks, trauma, and a myriad of other factors.

The same goes for mental illness. This isn't about treating the individual's symptoms with a medication alone. Access to food, housing, medical care, and basic preventative measures from childhood onward contribute to the overall mental health of an individual. When our children have better access to the care they need, they grow into adults who contribute to the better communities we need.