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Mental Health Parity Earns Praise in Maine - but Coverage Gaps Remain
11/12/2013   Reported By: Patty B. Wight

It's being touted as the crown achievement in ending health insurance discrimination: Last week, the federal government issued the final rule on so-called mental health parity. It's a law that requires insurance companies to cover mental health and substance abuse treatments the same way they cover physical ailments. But as Patty Wight reports, those needing such treatment in Maine face other barriers, including a shortage of psychiatrists.

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The parity law has been 20 years in the making: Congress first enacted it in 1996 to address mental health, then expanded the law in 2008 to include substance abuse treatment. But given the complex nature of the U.S. health care system, it wasn't until last Friday that the Obama administration issued clarity on how the law should be implemented.

"You know, one of the things that this kind of effort does is create an acceptable floor," says Jenna Mehnert, executive director of NAMI - the National Alliance on Mental Illness - in Maine. While some insurance companies have already incorporated parity into their plans, Mehnert says establishing a legal minimum requirement is a huge step.

"Lower cost health insurance benefits in the past didn't always include - and often didn't include - mental health services or substance abuse treatment," Mehnert says.

Beyond insurance requirements, the executive director of Community Health and Counseling Services, Dale Hamilton, says the parity law also supports a cultural shift by recognizing mental health and substance abuse as legitimate medical issues.

"And the stigma that gets associated and attributed to it sometimes prevents people from reaching out and accessing those services," he says. "So I certainly hope that, as laws like this are implemented, that it also sends a message that, yes, this is a health issue."

The executive director of Wellspring Substance Abuse and Mental Health Services, Pat Kimball, says substance abuse, in particular, is a condition that insurers often don't cover, and that comes at a cost.

"Our substance abuse has a billion dollar price tag on it," she says. "Untreated substance abuse cost the state $1 billion last year."

That's for things like missed time at work, case management, and incarceration. Kimball says studies have found that people often don't call for substance abuse help because they don't have the money to cover treatment.

Lack of coverage is frustrating for providers too, says Dr. Jeffrey Barkin, the president of the Maine Association of Psychiatric Physicians. "All of us who have treated patients with psychiatric disorders have had to deal with frequent insurance rejections," he says.

Barkin says payment rates to psychiatrists in the past have been so low that they effectively minimized coverage. And in Maine, Barkin says, there's already a shortage of psychiatrists for both children and adults.

"And it's my hope that by making it so providers can actually get paid for the services they render, we will create an incentive for more psychiatrists to come to the state of Maine to practice, and actually help our population be terrific," he says.

Just as Barkin hopes the parity law will close the gap in provider coverage, Pat Kimball of Wellspring says there is yet another gap that needs to be addressed. "We have a lot of people - many people - without any insurance coverage at all," she says.

Those below 100 percent of the federal poverty level don't qualify for subsisides to purchase insurance on the new online marketplace under the Affordable Care Act. Barkin says if Maine opted to expand Medicaid, it would close that coverage gap and reduce costs, while creating a healthier, more productive population.

Gov. Paul LePage opposed a measure to expand Medicaid last year, saying the state can't afford to incur more health care costs. The Maine Legislature will consider the measure again in January.


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