Advertisement

Impact of Mental Health Parity and Addiction Equity Act on Costs and Utilization in Alabama's Children's Health Insurance Program

Published:August 02, 2018DOI:https://doi.org/10.1016/j.acap.2018.07.014

      Abstract

      Objective

      The Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 mandates equivalent insurance coverage for mental health (MH) and substance use disorders (SUD) to other medical and surgical services covered by group insurance plans, Medicaid, and Children's Health Insurance Programs (CHIP). We explored the impact of MHPAEA on enrollees in ALL Kids, the Alabama CHIP.

      Methods

      We use ALL Kids claims data for October 2008 to December 2014. October 2008 through September 2009 marks the period before MHPAEA implementation. We evaluated changes in MH/SUD-related utilization and program costs and changes in racial/ethnic disparities in the use of MH/SUD services for ALL Kids enrollees using 2-part models. This allowed analyses of changes from no use to any use, as well as in intensity of use.

      Results

      No significant effect was found on overall MH service-use. There were statistically significant increases in inpatient visits and length of stay and some increase in overall MH costs. These increases may not be clinically important and were concentrated in 2009 to 2011. Disparities in utilization between African-American and non-Hispanic white enrollees were somewhat exacerbated, whereas disparities between other minorities and non-Hispanic whites were reduced.

      Conclusions

      Findings indicate that MHPAEA led to a 14.3% increase in inpatient visits, a 12.5% increase in length of inpatient stay, and a 7.8% increase in MH costs. The increases appear limited to 2009 to 2011, suggesting existing pent-up “needs” among enrollees for added MH/SUD services that resulted in a temporary spike in service use and cost immediately after MHPAEA, which subsequently subsided.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Academic Pediatrics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. H.R.2—Children's Health Insurance Program Reauthorization Act of 2009. Available at: https://www.congress.gov/bill/111th-congress/house-bill/2. Accessed September 30, 2018.

        • Beronio K
        • Glied S
        • Frank R
        How the Affordable Care Act and Mental Health Parity and Addiction Equity Act greatly expand coverage of behavioral health care.
        J Behav Health Serv Res. 2014; 41: 410-428
        • Barry CL
        • Busch SH
        Do state parity laws reduce the financial burden on families of children with mental health care needs.
        Health Serv Res. 2007; 42: 1061-1084
      2. “Mental Health Benefits: State Laws Mandating or Regularing.” National Conference of State Legislatures. Available at: http://www.ncsl.org/research/health/mental-health-benefits-state-mandates.aspx. Accessed September 30, 2018.

        • Robinson GK
        • Connolly JB
        • Whitter M
        • et al.
        State Mandates for Treatment for Mental Illness and Substance Abuse Disorders.
        US Dept of Health and Human Services Substance Abuse and Mental Health Services Administration, Rockville, MD2006
        • Frank RG
        • Glazer J
        McGuire TG. Measuring adverse selection in managed health care.
        J Health Econ. 2000; 19: 829-854
        • Manning WG
        • Wells KB
        • Buchanan JL
        • et al.
        Effects of Mental Health Insurance: Evidence From the Health Insurance Experiment.
        RAND Corporation, Santa Monica, CA1989
        • Newhouse JP
        • RCIE Group
        Free for All? Lessons From the RAND Health Insurance Experiment.
        Harvard University Press, Boston, MA1993
        • Deb P
        • Wilcox-Gök V
        • Holmes A
        • et al.
        Choice of health insurance by families of the mentally ill.
        Health Econ. 1996; 5: 61-76
        • Frank RG
        • Koyanagi C
        • McGuire TG
        The politics and economics of mental health ‘parity' laws.
        Health Aff (Millwood). 1997; 16: 108-119
        • Pacula RL
        • Sturm R
        Mental health parity legislation: much ado about nothing?.
        Health Serv Res. 2000; 35: 263
        • Zuvekas SH
        • Regier DA
        • Rae DS
        • et al.
        The impacts of mental health parity and managed care in one large employer group.
        Health Aff (Millwood). 2002; 21: 148-159
        • Busch SH
        Implications of the Mental Health Parity and Addiction Equity Act.
        Am J Psychiatry. 2012; 169: 1-3
        • McConnell KJ
        • Gast SHN
        • Ridgely MS
        • et al.
        Behavioral health insurance parity: does Oregon's experience presage the national experience with the Mental Health Parity and Addiction Equity Act?.
        Am J Psychiatry. 2012; 169: 31-38
      3. All Kids Children's Health Insurance Program.
        ALL Kids-Benefits. 2012; (Available at:) (Accessed October 1, 2017)
      4. Henry J Kaiser Foundation. CHIP program name and type. Available at: https://kaiserf.am/2Bfow6T. Accessed July 11, 2018.

      5. Ross DC. A foundation for health reform: findings of a 50-state survey of eligibility rules, enrollment and renewal procedures, and cost-sharing practices in Medicaid and CHIP for children and parents during 2009. Kaiser Family Foundation. 2009. Available at: https://kaiserfamilyfoundation.files.wordpress.com/2013/01/8028_t.pdf. Accessed July 11, 2018.

        • Goldman HH
        • Frank RG
        • Burnam MA
        • et al.
        Behavioral health insurance parity for federal employees.
        N Engl J Med. 2006; 354: 1378-1386
        • Azrin ST
        • Huskamp HA
        • Azzone V
        • et al.
        Impact of full mental health and substance abuse parity for children in the Federal Employees Health Benefits Program.
        Pediatrics. 2007; 119: e452-e459
      6. National Alliance on Mental Illness. A long road ahead: achieving true parity in mental health and substance use care. Available at: https://www.nami.org/About-NAMI/Publications-Reports/Public-Policy-Reports/A-Long-Road-Ahead/2015-ALongRoadAhead.pdf. Accessed October 1, 2017.

        • Herrera C
        • Hargraves J
        • Stanton G
        The Impact of the Mental Health Parity and Addiction Equity Act on Inpatient Admissions.
        Health Care Cost Institute, Washington, DC2013