After Newtown Shootings: Questions about Mental Health Insurance Coverage

By Jenny Gold, Kaiser Health News

On Monday White House spokesman Jay Carney pointed to the federal health law as evidence that the administration has already started to tackle the issue. Mental health issues are "clearly a factor that needs to be addressed in some of these cases of horrific violence," Carney said. "Obamacare, if you will, has ensured that mental health services are a part of the services" provided under the health law.

While the Affordable Care Act, along with the Mental Health Parity Act of 2008, go a long way toward assuring coverage for most Americans, some gaps remain.

Here are some answers to frequently asked questions about mental health coverage:

Didn't the Mental Health Parity Act already guarantee coverage for Americans with insurance?

The Mental Health Parity and Addiction Equity Act, signed into law in 2008, made a big dent in the problem of mental health coverage. But it depends on how you get your insurance

• Large Employers (more than 50 workers): If large companies include mental health services in their insurance plans, they must cover those services at same or higher level as other medical conditions. That means that the plans could not provide fewer inpatient hospital days or require higher out-of-pocket costs, more cost sharing or separate deductibles for mental health conditions. But Paul N. Samuels, director and president of the Legal Action Center, says that some people still aren't receiving equal coverage, and the law is not always enforced. "That's a problem we're really concerned about," he says. Note that large employers are not required to offer mental health insurance, but most do.
• Small Business/Individual Plans: Not included in the Parity Act.

In short, whether you have mental health coverage in an employer-sponsored insurance plan depends on where you work.

What if I don't have mental health coverage in my employer’s insurance plan? Will the ACA change that?

Small group and individual plans will be required to offer the coverage in 2014 through health exchanges created under the law. But employers with 50 or more workers can continue to not offer the benefits.

I'm planning to buy an insurance plan through one of the new exchanges. What kind of mental health coverage will I have?

Again, as noted above, all plans sold in the exchanges will be required to provide coverage for mental health and substance abuse. The exchanges will be open to individuals and small businesses.

The same rules will apply to small group and individual plans purchased outside of the exchange.

In other words, beginning in 2014, if you (or your small employer) are purchasing any new insurance plan, coverage will include mental health benefits on par with any other medical condition.

I'll be covered under the Medicaid expansion authorized by the law. What kind of mental health coverage will I get?

If you earn less than 138 percent of the federal poverty level (about $32,809 for a family of four), you may be newly eligible for Medicaid coverage in 2014. Like people who purchase coverage through the exchange, new Medicaid beneficiaries will receive mental health benefits on par with other medical or surgical needs.

What problems might arise?

While the ACA "provides enormous potential and opportunity to make sure than many millions more Americans obtain the services they need," says Samuels, "that will only happen if the implementation of those reforms is effective." Samuels worries that the rules from HHS will not be clear or strong enough to make the parity laws meaningful. He also worries about getting everyone who is eligible for coverage enrolled, particularly those with severe mental health disorders who be may homeless or living on the fringes of society.

Access to treatment will likely also remain a serious stumbling block. As many as 30 million people are expected to gain insurance coverage beginning in 2014. Of those, the U.S. Substance Abuse and Mental Health Services Administration estimates that 6 to 10 million will have untreated mental illnesses or addiction, adding additional demands to a system that is already overwhelmed. Patients may experience long wait times to see a psychiatrist, for example, and may require additional investments to expand the mental health workforce.

Learn More: KQED Forum Shooting Puts Spotlight on Mental Health