Final Parity Ruling and Obamacare

healthinsurance2Cause for celebration or just one victory in a long-term battle

On November 8, 2013 the Obama administration released the final rule providing guidance on how health insurance plans should implement mental health parity. In short, the rule states that mental health coverage must be equitable to how insurance plans cover other physical conditions. Restrictions accessing care and reimbursement for services can no longer be different for mental health in relation to other health care services. Additionally the ACA, more popularly known as Obamacare, requires that mental health coverage be included as an essential health benefit for plans available through the market exchange.  In short, as of January 1, 2014 private, marketplace exchange and Medicaid Expansion plans must offer mental health care and it must be with parity.

Much has been written about the ruling. Most of it positive. Bloomberg BNA states advocates are praising the rule. The National Council applauds the ruling saying it is “a huge victory for people living with mental health needs and for the nation as a whole.

CFYM has covered the topic in past blogs and has provided instructions on how to fight for your coverage rights by challenging an insurance claim denial. Carol McDaid of the Parity Implementation Coalition posted on September 19 that now is the time to become an informed, empowered, and vocal consumer. There is much work still to be done to ensure the civil rights and protection of people living with a mental health condition when it comes to access, however.

Employers with 50 or fewer employees are exempt from Obamacare. This means that 96% of businesses do not need to offer their employees plans.  Further, in a recent conversation Click here to listen to the conversation between KHN’s Mary Agnes Carey and CQ HealthBeat’s Rebecca Adams more red flags in this fight were revealed. It was reported that the rule states that insurers can be exempt from parity if their costs go up by 2% in the first year and 1% in subsequent years. While Rebecca Adams is of the opinion that the impact of this loop hole will be minimal, it is a detail mental health advocates need to be on the look-out for.

Medicaid managed care plans are also exempt from the plans. This applies to Children’s Health Insurance Programs as well. The Centers for Medicare & Medicaid Services did issue a letter to State Medicaid officials in January reporting their endorsement of parity. However, final determination of how parity is implemented is left up to the states. Many states are currently not implementing full mental health parity as part of the roll-out.  Additionally, states are not required to participate in Medicaid Expansion.  As a result, the mental health parity fight is shifting to the states, and away from the federal spotlight.

The wins for access to quality mental health coverage have been significant in 2013, and we all have cause for celebration.  However before we rest on our laurels, it is important to remember that these victories are part of a long-term fight.  As advocates we need to continue to fight for quality mental health coverage for all Americans.  While looking for where the next battles will be fought, look no further than your state general assemblies.  Making sure that Medicaid Expansion and implementation of parity rules are equitable in your state will require vigilance.

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Provider capacity is indeed a problem in both inner-city and rural deserts. As of November 14, 2013 there are currently approximately 3,700 Mental Health – Health Professional Shortage Areas. Mental Health HPSAs are based on a psychiatrist to population ratio of 1:30,000. Reforming Medicare and Medicaid reimbursement models to fully fund integration of peer specialists and peer support groups into treatment models has the potential to increase the quality of and access to mental health care, while reducing costly hospitalization length of stays and readmissions – a policy we could all get behind.

Mary Beth Dunkenberger
Mary Beth Dunkenberger

The parity law is certainly a move in the right direction, however a true free market marketplace assume a supply and demand equation that involves the good, the demand for the good and the ability to pay. While we most certainly have the demand, and the parity law seeks to ensure the ability to pay, in too many communities there is still a lack of mental health services, especially for the most vulnerable and acutely ill.Moving the provision of acute mental health services, from the public sector to the private sector has failed in many contexts, especially rural communities.If the parity law is to meet its intended goals this market imbalance needs to be remedied.