12 Strategies to Achieve Mental Health Parity

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Shone Hughes
August 16, 2024

Our nation is experiencing a mental health crisis! An estimated 20 percent of adults in the United States have a mental health condition. Nearly 50 million individuals aged 12 years and older have a substance use disorder. 7.7 million adults experience major comorbidity of mental illness and substance use.  Approximately 8.1 million calls, text messages and chats were made to the 988 Suicide and Crisis Lifeline received by trained crisis counselors. This is a 33 percent increase from the 2022 implementation year. 

Since the enactment of the Affordable Care Act (ACA), most individuals and health insurance plans require insurers to cover mental health and substance use disorder treatment and not impose arbitrary limitations. The plans must comply with the Mental Health Parity and Addiction Equity Act (MHPEA) which seek to address benefit disparities in treatment and services between behavioral health and physical health. Mental health and substance abuse disorder coverage cannot be more restrictive than coverage for physical health. In other words, if an insurer provides mental health and substance abuse coverage, the insurer cannot charge higher deductibles and copayments for mental health and substance abuse disorder treatment including rehabilitative treatment. This is referred to as parity.

Despite the Affordable Care Act (ACA) federal parity requirement that mandates insurance companies providing behavioral health coverage ensure that coverage is comparable to physical health benefits, millions of Americans lack access to quality behavioral health treatment. 

Mental Health Disparity

Accessing mental health and substance use treatment pose significant challenges for certain populations. In speaking with a group of older Generation Zers who sought mental health treatment, most were without employer sponsored health insurance. For this group, accessibility was noted as the most challenging aspect of receiving timely treatment. The cost of therapy was the most significant barrier to treatment. The average cost for a therapy session was $150.00. One savvy individual was able to negotiate discounted therapy sessions for cash payments when an insurer limited therapy sessions.

Adults with no or low income with a mental health disorder and/or substance abuse disorder, Medicaid coverage is a lifeline. Unfortunately, individuals living below the federal poverty line in rural areas plagued with methamphetamine and opioid crises often have limited access to mental health and substance use treatment providers that accept Medicaid. The wait time to receive treatment can exceed two months.

The aging population and African Americans in urban centers face a similar gloomy situation. These populations experience higher incidences of trauma and accidental drug overdose yet gross disinvestment in community behavioral health services. The shift to privatize mental health care further exacerbated disparities in wait time to receive affordable treatment and the latest evidence based treatment options.

Achieving Mental Health Equity

The ability to access quality and timely health care should be a top priority on the local and state levels. Mental health and substance use disorder treatment disparities have a profound negative impact on all aspects of an individual’s life. Untreated mental health results in a loss of income, unlawful behavior and disruptions in education which are just some of the consequences. Mental health disorders and substance use disorders are treatable diseases that can ultimately lead to premature death when neglected. We must make mental healthcare more accessible for everyone.

12 Policy Recommendations to Achieve Parity

• Improve Medicare mental health and substance abuse
• Provide Medicare coverage for mobile crisis intervention.
• Remove arbitrary state restrictions on telehealth services.
• Provide incentives to mental health professionals providing telehealth services for individuals in high need communities.
• Permit licensed mental health and substance use counselors to deliver teleservices out of state and receive Medicaid and Medicare reimbursement.
• Forge public and private partnerships to open community mental health centers in rural and urban communities.
• Fund quality accredited residential treatment options staffed with 24 hour licensed behavioral health
• Provide incentives for community health organizations to eliminate wait times among populations in great need.
• Administer sanctions for insurers that charge higher deductibles and copayments for mental health treatment and rehabilitative services.
• State investment in a 988 Suicide and Crisis Lifeline trust fund.
• Utilize property tax revenue from non-homeowner exempt property owners to support community behavioral health treatment.
• Improve reimbursement for out of network behavioral health providers.

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Author: Shone Hughes is an Assistant Professor in the College of Public Service at Tennessee State University. Dr. Hughes’s interests include social equity, program evaluation, and health policy. 

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