SCHIP mental health parity: Outlook is unclear

By Nicole Lucht

Friday, Feb. 20, 2009 | 2 a.m.

It remains to be seen whether mental health parity will be good for the emotional health of children on the state’s Children Health Insurance Program.

Parity requires mental illness treatments be covered at the same level as other medical care. For instance, premiums for mental health care cannot be higher than physical health care. However, parity does not mandate that any treatments are covered.

Mental health parity was added to the bill reauthorizing funding for the program, and was signed into law by President Barack Obama on Feb. 4.

The children’s health insurance program, initiated in 1997, is an expansion of Medicaid. Nationwide, 7.4 million children are enrolled in the low-cost health program, according to the Centers for Medicare and Medicaid Services. In Nevada 22,500 low-income children are enrolled, according to the state’s Health and Human Services Department. States and the federal government fund the insurance program jointly.

This addition of mental health parity to the children’s insurance program is similar to the legislation signed in October by President George W. Bush as part of the first bailout bill requiring insurers to provide mental health coverage on par with other medical care, but does not mandate mental health care be provided in an insurance plan.

“Unfortunately there is no mandate of mental health coverage in SCHIP plans,” said Laurel Stine, director of federal relations for Bazelon Center for Mental Health Law, a national advocacy group for people with mental disabilities. “Plans definitely don’t have to provide mental health coverage.”

But children’s insurance plans around the country are already offering some level of mental health coverage, she said.

Amerigroup covers 280,000 children in 12 state health insurance programs, including Nevada, company spokesman Kent Jenkins said. He said he was not aware of what effect mental health parity would have on that coverage.

“We’re not in the business of determining eligibility. That is a state issue,” Jenkins said.

He said he hasn’t noticed any “discernible change” in other insurers’ coverage of mental health when parity was added to the federal bailout bill.

That portion of the legislation, however, doesn’t go into effect until this October, with most plans not reflecting the change until January.

Stine said that her advocacy group would “definitely” push for a mandate on mental health coverage.

The group, which pushed for the change, considers children’s health insurance a “down payment” on health care reform, and will continue pushing for a mental health care mandate.

“We don’t know how health care reform will progress, we do believe that existing entitlement programs like Medicaid should have some integrity to those programs given that they cover a variety of services that children and adults with mental health conditions need,” Stine said. “We want to make sure that mental health is mandated and is a required benefit.”

Concerns were raised during the parity debate that coverage would be dropped or reduced, but historically that has not been the case, she said.

“I think the country is shifting, that advocates at the state level are not going to allow that as well, so there is going to be pressure on that,” she said.

Nevada Assemblywoman Sheila Leslie said in an e-mail that although she is not yet familiar with the parity addition to the children’s insurance program, the last time parity was added on a state level was in 1999. Leslie is a strong advocate of mental health care.

“Historically, the fear that mental health coverage would be dropped due to parity requirements has not happened to any great extent,” she said.

The Congressional Budget Office, in reviewing the mental health parity requirements for private plans in 2007, said that the increase to premiums would be a negligible 0.4 percent.