One of us is a national health behavior advocate whose peer support work sparked a decade-long journey to reform the system. As a peer advocate, I have worked with a number of youth and young adults who have been involved in insurance nightmares. One person’s therapist stopped getting insurance after two years because she wasn’t getting paid on time and was losing money from low reimbursement. They were unable to pay and went without care for the remainder of their college education. Another young adult turned 26 and found that his therapist of six years was suddenly out of network now that they had dropped out of their parents’ insurance plan. They were forced to find a new therapist, and more than half of the providers on the plan’s list never responded.
One of us has worked as a social worker and knows the aggravation, even the deadline, of not receiving care. A report by the Bowman Family Foundation found this 57% of people who sought mental health or substance use care were unable to at least once between January 2019 and April 2022.
If you or someone you love has ever needed mental health care, you likely have a similar story of frustration and difficulty finding a mental health provider that will take your insurance or not have an incredibly long wait. The good news is that we can all improve this experience and gain greater access to care by expressing our support for the July Biden administration. proposed rule to implement the Mental Health and Addiction Parity Act (MHPAEA).
Enacted 15 years ago, the MHPAEA required insurers to treat mental and physical health equally in insurance practices. Families were celebrating, thinking they would finally have access to critical mental health and substance use care. This never happened. Since then, insurers have poked so many loopholes in the Act that access to mental health and substance use care is not only increasingly difficult for everyone, but places a heavy burden on children and their caregivers during a mental health crisis.
Insurers are quick to cite behavioral labor shortages as an excuse, while ignoring how their practices contributed to the shortage, such as paying prices too low compared to the market, keeping networks closed, designing burdensome pre-approval requirements and the delay and refusal of payment. The proposed rule would significantly strengthen parity enforcement, prohibit insurers from using more restrictive prior authorization, reduce arbitrary barriers, and bring us closer to the original promise of equal care.
Insurers establish standards for denying claims. A district court in Wit v. United Behavioral Health found that one of the nation’s largest insurers was writing medical necessity standards specifically to deny behavioral health care and save money, ignoring established guidelines from medical companies. As the Administration notes in a Fact Sheetthe proposed rule would “make clear that health plans must evaluate the effects of coverage rules to ensure that people have equivalent access between their mental health benefits and their medical benefits.”
Insurers are also escaping untested “ghost networks”. A recent study in Health Affairs of Oregon’s Medicaid program found that more than two-thirds of mental health prescribers and 59% of other mental health professionals listed on the state’s insurance rolls were “ghosts.” That is, insurer plans appear to offer many in-network mental health options, but the reality is that those lists include disconnected lines, providers that do not accept new patients, and out-of-pocket options. The proposed rule would require “the evaluation of the health plan’s actual network of providers.”
These changes cannot come fast enough. During an extraordinary youth crisis, our nation’s youngest are feeling the effects.
Insurance data shows that children’s mental health visits are 1,000% more likely to be offline from physical health visits, meaning families are forced to pay out of pocket or even skip needed mental health care.
We need the toughest regulations possible, especially for our young people struggling with their mental health. That’s what the numbers from the Mental Health America Screening tell us 38% of testers who sought help for mental health problems in the US last year were under 18, 48% of youth depression researchers reported frequent suicidal ideation, and rates of suicidal ideation are highest among youth, especially LGBTQ+ youth of color. The administration should strengthen the proposed rule to ensure that there are no exceptions to the careful consideration of whether an insurance practice treats people fairly.
Critics of the rule say it will impose a reporting burden on employers and insurers. However, it will not be a burden if their practices are fair and treat mental and physical health equally. The real burden is on families who have to pay high costs or forego care.
If you want to be serious about responding to the youth mental health crisis, you must be serious about demanding equality of care. Now is the time for all of us, from young people to adults, to raise our voices, submit comments on this new parity rule and tell insurers that we will no longer accept less help for mental health and addiction care. Click here to submit a comment.
Kenna Chic is a national behavioral health advocate, past chair of Project Lighthouse Peer-Support System, and past member of MHA’s Mental Health Innovation Collegiate Council. Schroeder Stribling is president and CEO of Mental Health America and a former social worker.
