Unfair & Unequal Coverage Significantly Affects Access to Mental Health Care, Finds New Report

Unfair & Unequal Coverage Significantly Affects Access to Mental Health Care, Finds New Report

Apr 17, 2024

Throughout NAMI’s 45-year history, mental health parity has been a top priority. Parity means covering mental health and addiction care at the same level as other health care. Despite laws requiring mental health parity in many health plans, a landmark report released today by the nonprofit research institute RTI International, Behavioral Health Parity – Pervasive Disparities in Access to In-Network Care Continue, provides new insights about the ongoing barriers people with mental health conditions encounter when trying to access mental health care.

“Every day, we hear from people struggling to find affordable, accessible mental health care,” said NAMI CEO Daniel H. Gillison, Jr. “This report shows what we have all experienced – accessible mental health care is hard to find in-network. The findings illustrate a drastically inequitable reality for people trying to access mental health care and provide a call to action for regulators to hold health insurance companies accountable for providing parity coverage, as required by the Mental Health Parity and Addiction Equity Act.”

The report, which covers commercial insurance data for over 22 million Americans between 2019 and 2021, found: 

• People are forced to seek care from higher cost, out-of-network providers for mental health and substance use treatment – at far higher rates than for other medical and surgical care. Out-of-network network use was 3.5 times higher for mental health and substance use disorder (MH/SUD) treatment compared to medical/surgical (M/S) treatment, meaning people with mental illness have to pay more for their care.
• Mental health providers are routinely paid less than other M/S providers. Average in-network office visit reimbursement was 22 percent higher for M/S clinicians than for MH/SUD clinicians, disincentivizing MH/SUD providers from joining insurance networks and making it harder for people to access mental health care within their network.  

NAMI supports the recommendations made by the researchers, including: increasing MH/SUD provider reimbursement rates, reducing the administrative burden on providers and fast-tracking credentialing and other network admission requirements, as well as auditing insurers’ provider network directories. Additionally, the report recommends federal and state agencies use standardized templates to identify parity violations and notes specific methodologies that they should use. NAMI will continue advocating to strengthen parity and improve access to quality, affordable mental health care for all Americans.

Read the full report here and key findings and recommendations here.