Grading New Hampshire’s Parity


It’s been a decade since President George W. Bush signed the Mental Health Parity and Addiction Equity Act into law, signaling a need for regulations surrounding the role insurance companies play in the delivery of mental health services to a state’s residents.

More commonly known as the Federal Parity Law, the legislation requires insurers to cover illnesses connected to the brain (depression or addiction, for example) with equal restrictiveness to those associated with the body (such as diabetes or cancer). The law was intended to keep pace with the growing body of research and work connected to the importance of maintaining proper mental health coverage in our communities across the country. Since most state residents gain access to mental health care through their insurance carrier this law is a crucial instrument in place to make sure insurance companies honor this aspect of one’s overall health plan.

What does this mean in real practice? Since most seeking mental health help gain affordable access through their insurance carriers, it’s important that these companies reflect equity in providing coverage for both “body” and “brain” illnesses and reimburse providers for their participation in their coverage. If insurers don’t provide adequate reimbursement, providers drop out and those seeking help have to increasingly go “out of network”, a move which can become increasingly more costly until they stop trying to get help at all. This completely goes against the purpose of the Federal Parity Law.

A report published by Milliman in December of 2017 offers an in-depth look at state compliance of this law using three years of data and for many states, the news isn’t good. How do states fail to meet parity standards prescribed by this law? Here are some of the most common practices:

  • Insurer requires the patient to pay a separate deductible or higher co-pays for mental health-related services.
  • Insurers set limits on how many days one can stay at a treatment facility or how many times they can see a treatment provider, such as a counselor or other mental health professional.
  • Insurer charges more for medication for behavioral treatment.
  • Insurer requires patient to get permission before starting mental health treatment program.
  • Insurer forces patient to seek cheaper treatment than the recommended program by a doctor.
  • Insurer refuses to pay for treatment recommended by a doctor.
  • Insurer refuses to pay for treatment provided outside patient’s state or region.

These practices can significantly reduce or eliminate access for a resident seeking important mental health treatment, further adding to the already growing set of mental health challenges currently faced by those living in states across the country.

New Hampshire earned a “C” in this study (71 out of 100 points), indicating that while the state hasn’t ignored the insurance component in mental health care access for its residents, there is much work to be done to most effectively comply with federal law.

Among the main findings and recommendations concerning New Hampshire in the report:

  • Over one in five NH residents have a mental illness (national average: 1 in 6).
  • Approximately one in nine NH residents have no insurance coverage for their mental illness (national average: 1 in 7).
  • Over one in 12 NH youth have a mental illness (national average: 1 in 12).
  • One in 22 NH youth have no private insurance coverage for mental illness (national average: 1 in 13).
  • 58 percent of NH residents have insurance coverage through their employer (national average: 49%).

The report recommended that New Hampshire address the following areas to improve its overall rating:

  • Define more clearly what constitutes mental health and addiction conditions.
  • Define more clearly how mental health and addiction conditions are covered.
  • Provide clearer guidelines on how compliance with this federal law is monitored and enforced.

Young people in New Hampshire suffer from mental illness in slightly higher rates than those in other states and for most of these kids, the only help they receive is through insurance providers, companies tasked with providing equity for various conditions, mental health related included. The Federal Parity Law was implemented to keep this crucial help available through the most common instrument available to the state’s young people–insurance companies.

There are things you can do if you have questions. Reach out to your insurance company for more information on this law and your insurer’s compliance with its components. If you want to research further, visit this Parity Registry for more information regarding a wide range of issues connected with this law.

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