A Healthy Blog

Massachusetts health care — wonky, with a healthy dose of reality

Children's Mental Health - Parity Matters for Kids, too

Children's Mental Health - Parity Matters for Kids, too

May 17, 2016

What is Parity? And what does it mean for kids?

Children's Mental Health CampaignYou may have heard of Mental Health Parity, but what exactly does it mean?  When talking about parity in mental health care, we mean fairness with regard to health insurance coverage. The goal is that with fair insurance coverage of mental health and addiction services, there will be better access to treatment which will lead to improved health. The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA or the Federal Parity Law) requires most health plans to cover the mental health and substance use disorder benefits they offer in a comparable way to physical health benefits the plans offer.  MHPAEA does not require health plans to provide mental health or substance use disorder benefits, but if a plan does offer these benefits, it must do so in a fair way when compared to physical health benefits. Some health plans are exempt from the Federal Parity Law, including Medicare and TriCare (military health benefits).

For the 17.1 million children with behavior health needs living in the United States, Mental Health Parity is critical to ensuring kids receive the treatment they need. Limited and inequitable coverage of Mental Health services is not only a financial burden for families struggling to pay for appropriate services for their children, but it also contributes to the pervasive stigma that surrounds mental health conditions.

The Rules

The Federal Government has issued regulations which help explain how health plans must comply with the Federal Parity Law. There is one rule for private health insurance plans (such as plans offered by private employers to their employees) and another rule for the public health insurance programs Medicaid and the Children's Health Insurance Program (CHIP).  In Massachusetts, Medicaid and CHIP plans are both referred to as MassHealth. The Federal Parity Law does not apply to all  MassHealth members, but only to those in MassHealth Managed Care Organizations (MCOs), the CarePlus plan and MassHealth Family Assistance (CHIP plan). One important aspect relating to children is that for CHIP Plans, if the CHIP plan offers Early and Periodic Screening, Diagnosis and Treatment (EPSDT), the plan will be deemed in compliance the Parity Law.  While there are separate rules for private and public health plans, there is a lot of overlap between the rules. If you are interested in learning more about the details of the law, click here to read more.

The Children’s Mental Health Campaign’s goal is to help improve Massachusetts mental health care system for children.  Health Law Advocates is assisting in this effort by ensuring that Parity Law gets enforced.  If you live or work in Massachusetts and think you or someone you know has experienced a mental health parity violation or your insurance plan has denied you coverage of mental health or substance use disorder services, please contact HLA, at (617) 338- 5241 or (888) 211-6168 (toll-free number).  You can also visit the HLA's website at www.healthlawadvocates.org/.   To learn more about HLA's Children’s Mental Health Access Project, which includes our Juvenile Court Advocacy Project, click here.