Factors Affecting State-Level Enforcement of the Federal Mental Health Parity and Addiction Equity Act: A Cross-Case Analysis of Four States

Author:

Presskreischer Rachel1,Barry Colleen L.2,Lawrence Adria K.3,McCourt Alexander3,Mojtabai Ramin3,McGinty Emma E.4

Affiliation:

1. Columbia University Mailman School of Public Health

2. Cornell Jeb E. Brooks School of Public Policy

3. Johns Hopkins University

4. Weill Cornell Medical College

Abstract

Abstract Context: The Mental Health Parity and Addiction Equity Act (MHPAEA) requires coverage for mental health and substance use disorder (MH/SUD) benefits to be no more restrictive than for medical/surgical benefits in commercial health plans. State insurance departments oversee enforcement for certain plans. Insufficient enforcement is one potential source of continued MH/SUD treatment gaps among commercial insurance enrollees. This study explored state-level factors that may drive enforcement variation. Methods: The authors conducted a four-state multiple-case study to explore factors influencing state insurance offices' enforcement of MHPAEA. They interviewed 21 individuals who represented state government offices, advocacy organizations, professional organizations, and a national insurer. Their analysis included a within-case content analysis and a cross-case framework analysis. Findings: Common themes included insurance office relationships with other stakeholders, policy complexity, and political priority. Relationships between insurance offices and other stakeholders varied between states. MHPAEA complexity posed challenges for interpretation and application. Policy champions influenced enforcement via priorities of insurance commissioners, governors, and legislatures. Where enforcement of MHPAEA was not prioritized by any actors, there was minimal state enforcement. Conclusions: Within a state, enforcement of MHPAEA is influenced by insurance office relationships, legal interpretation, and political priorities. These unique state factors present significant challenges to uniform enforcement.

Publisher

Duke University Press

Subject

Health Policy

Reference54 articles.

1. AHIP (America's Health Insurance Plans). 2021. “Health Coverage: State-to-State 2021.” May3. https://www.ahip.org/resources/health-coverage-state-to-state-2021.

2. Bernstein Lenny . 2022. “Equal Mental Health Insurance Coverage Elusive Despite Legal Guarantee.” Washington Post, June2. https://www.washingtonpost.com/health/2022/05/25/equal-mental-health-insurance-coverage-elusive-despite-legal-guarantee/.

3. Block Eryn P. , XuHaiyong, AzocarFrancisca, and EttnerSusan L.2020. “The Mental Health Parity and Addiction Equity Act Evaluation Study: Child and Adolescent Behavioral Health Service Expenditures and Utilization.” Health Economics29, no 12: 1533–48. https://doi.org/10.1002/hec.4153.

4. Brown Christopher . 2022. “Planned Medicaid Work Rules' Impact at Heart of Georgia Lawsuit.” Bloomberg Law, February11. https://news.bloomberglaw.com/health-law-and-business/planned-medicaid-work-rules-impact-at-heart-of-georgia-lawsuit.

5. The Effects of Mental Health Parity on Spending and Utilization for Bipolar, Major Depression, and Adjustment Disorders.”;Busch;American Journal of Psychiatry,2013

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