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Finally we have the tools we need to ensure Medicaid appropriately serves behavioral health consumers. Last week, the Centers for Medicare and Medicaid Services (CMS) finalized the regulation that applies the 2008 Mental Health Parity and Addiction Equity Act (MHPEA) to Medicaid and the Children’s Health Insurance Program (CHIP). MHPEA, also known as the “federal parity law,” requires many health insurance plans to cover substance use and mental health services equally to, or at parity with, other covered medical benefits.
This regulation is the hammer we’ve been looking for – the powerful tool necessary to ensure full implementation of mental health and substance use disorders parity for millions of Americans covered by public health insurance programs. It is also an important lever for state advocates to use to address lingering behavioral health coverage and access disparities faced by people with substance use disorders and mental illness.
Many key provisions of the rule were finalized as proposed:
In a few areas, CMS improved the regulation based on feedback (thanks to those of you who weighed in!)
The regulation doesn’t officially go into effect for 18 months, but state Medicaid and CHIP programs can demonstrate their commitment to meeting consumer needs by implementing its provisions immediately. Consumer advocates are available to assist by highlighting coverage issues faced by consumers with mental illness and substance use disorders.
It’s also important to educate providers and consumers about the new requirements, so they can more easily identify problems that may be parity violations and bring them to the attention of Medicaid officials.
While the final regulation is good news, it does not guarantee robust enforcement. We still need better tracking of consumer complaints to Medicaid and other state agencies. And we need federal and state regulators to monitor Medicaid and CHIP programs to be sure they fully implement parity. If everyone works together, we can achieve the breadth and equity of treatment for substance use disorders and mental illness that our families and communities so desperately need.