Mental Health Parity

Where We Stand

NAMI believes that health insurance should provide comprehensive mental health and substance use disorder coverage without arbitrary limits on treatment. NAMI supports establishment and enforcement of laws and policies that ensure parity between mental health and physical health services in all forms of insurance coverage.

Why We Care

There is no health care without mental health care. As such, it is critical for health insurance to provide comprehensive coverage of mental health and substance use disorder services. Yet, too often, health insurance covers mental health care differently than other kinds of medical services, creating barriers to affordable, accessible mental health care and reinforcing a stigma around mental illness and seeking mental health treatment.

Parity is the basic idea that mental health and addiction care are covered at the same level as care for other health conditions. State and federal laws have attempted to address discriminatory practices in health insurance by creating requirements around parity. In 1996, the Mental Health Parity Act (MHPA) was the first federal law to create parity standards, but only for annual and lifetime dollar limits. In 2008, Congress passed the Mental Health Parity and Addiction Equity Act (MHPAEA) requiring comprehensive standards for equitable coverage of mental health and substance use disorder treatment and coverage of medical/surgical treatment. The 2010 Affordable Care Act (ACA) further expanded the reach of the parity laws by requiring most health plans cover mental health and substance use disorder care and expanding the scope of MHPAEA to reach most small group and individual markets. Additionally, states have enacted parity legislation to expand protections and/or improve compliance and enforcement of the federal laws. These efforts have helped create a more level playing field to treat mental and physical health conditions alike.

Still, disparities in mental health coverage remain. Some forms of insurance are allowed to place limitations on mental health coverage (for example MHPAEA does not apply to Medicare, certain state Medicaid programs, Veterans Administration or short-term limited duration health plans). The federal laws do not require parity in reimbursement rates and consequently, results in barriers to access as people cannot find in-network mental health care providers. Enforcing mental health parity is complex partly because a patchwork of federal and state entities are responsible for enforcement and the onus is largely on consumers to file individual claims of discrimination. NAMI strongly supports efforts to address these issues and achieve mental health parity in all forms of health coverage.

How We Talk About It

• There is no health care without mental health care.
• Unfortunately, mental illness is often treated differently than other health conditions by health insurance plans.
• That’s why parity — covering mental health and addiction care at the same level as other health care — has been a priority issue throughout NAMI’s history.
• About one in five adults in the U.S. has a mental health condition, and nearly 20 million people aged 12 and older have a substance use disorder.
• NAMI successfully fought for passage of a federal parity law in 2008 called the Mental Health Parity and Addiction Equity Act that was intended to improve coverage for mental health and addiction treatment.
• But millions of Americans were not covered by the federal parity law, leaving many excluded from the mental health and substance use coverage they needed.
• The Affordable Care Act (ACA) brought federal parity protections to people covered by individual and small group health plans.
• The ACA also eliminated many of the inequities that kept people with mental illness from accessing care by banning health insurance plans from discriminating against people with pre-existing conditions, like mental illness.
• Despite these laws, the promise of true parity has not been achieved, and many people with mental illness are still being denied the care that they need and deserve.
• People with mental health conditions struggle to find a mental health care provider in network or getting treatment approved by their health plan.
• And sadly, some forms of coverage, like Medicare and the Veterans Administration, are not required to even provide parity mental health coverage.
• State and federal policymakers must stop this discrimination and improve access to quality, affordable mental health care for all Americans by enforcing federal and state parity laws and requiring mental health parity in all types of insurance.

What We’ve Done

• NAMI and The Kennedy Forum guide on parity appeals.
• NAMI video What is Mental Health Parity
• NAMI news on an updated Milliman Report, Addiction and Mental Health Vs. Physical Health: Widening Disparities in Network Use and Provider Reimbursement
• NAMI statement on the announcement of a federal Mental Health and Substance Use Disorder Parity Task Force