When it comes to expanding health care access, enacting legislation is critical but barely half the battle. There is no better example than the struggle for fairness in insurance coverage for behavioral health care, or Mental Health and Addiction Parity.
It has been more than five years since the federal Mental Health Parity and Addiction Equity Act became law and 14 years since passage of the Massachusetts Mental Health Parity. Yet, because these laws aren’t strongly enforced, it is still more difficult for many consumers to obtain coverage for and therefore access to mental health or addiction treatment than other types of health care.
Health Law Advocates leads the way in Mental Health and Addiction Parity advocacy in Massachusetts. Our work starts with representing low-income clients denied access to mental health and addiction services. We opened 44 such cases in the first 8 months of 2014. One recent case involved “Stephanie”, a 52-year-old Lowell woman with major depression and breast cancer. Stephanie’s employer switched to a new out of state health insurer. The new insurer promptly denied coverage for a medication Stephanie had taken for years to treat her depression and infusions she was taking to treat her cancer. An HLA attorney quickly obtained coverage for the cancer treatment, but confronted substantial resistance from the insurer on coverage for the anti-depressant. Stephanie’s HLA attorney engaged in extensive negotiations with her health plan while preparing a formal appeal to challenge the denial. After a four-month dialogue, the health plan agreed to cover Stephanie’s medication without a formal appeal.
We also successfully advocate for landmark public policies to improve access to mental health and addiction services through more aggressive enforcement of the Parity laws. In 2012, HLA organized a Mental Health and Addiction Parity Coalition consisting of more than a dozen consumer and health care provider advocacy groups that were working independently to spur government enforcement of the Parity laws. Unified under HLA’s leadership, the Parity Coalition won enactment of a 2012 state law requiring the Division of Insurance (DOI) and MassHealth to issue their first-ever regulations enforcing the Parity laws. When these agencies wrote these regulations in 2013, HLA led the Parity Coalition’s efforts that secured pro-consumer provisions. The federal government in November 2013 also finalized long-awaited regulations enforcing the federal Parity law that included powerful consumer protections supported by HLA and advocates around the country that will improve access to mental health and addiction treatment.
HLA is also making a major commitment to educating the public about consumers’ rights to coverage for mental health and addiction services. We have held forums attended by hundreds consumers, clinicians, attorneys and other advocates throughout Massachusetts to increase awareness of the Parity laws and how to use them to access care.
HLA’s Mental Health and Addiction Parity Initiative is generously supported by Boston Children’s Hospital, the MetroWest Health Foundation, The Peter and Elizabeth C. Tower Foundation, the C.F. Adams Trust, and the Nord Family Foundation.