On March 29, 2016 the Centers for Medicare and Medicaid Services (CMS) finalized the long-awaited rule applying mental health and substance use disorders parity to Medicaid and the Children’s Health Insurance Program (CHIP).
Mental health and substance abuse parity means that a health plan pays for treatment as it would if the patient was being treated for any physical disorder. When a plan has parity, it means that if you are provided unlimited doctor visits for a chronic condition like diabetes, the health plan must offer unlimited visits for a mental health condition such as depression.
Community Catalyst’s Health Policy Hub blog post on April 7, 2016 highlights the important features of the rule.
These provisions of the rule were finalized as proposed:
All mental health and substance use disorders benefits offered through Medicaid managed care organizations (MCOs) have to follow the new rules.
Medicaid programs can’t avoid the rules just because it costs more.
Managed Care Organizations must disclose how they decide if a treatment is medically necessary for substance use disorders or mental illness, and the MCOs must provide explanations when they deny coverage. States must also publicly post documentation of compliance with parity rules.
Learn more about the rules by reading the full Community Catalyst blog.
Although states have 18 months to come into compliance with the parity regulations, there are three things advocates can start to do now:
Get in touch with state health department and Medicaid officials. Advocates can highlight stories of Medicaid and CHIP consumers who aren’t getting the mental health and/or substance use disorders care they need and urge officials not to wait 18 months to bring the Medicaid program into compliance with parity rules. Consumers should not have to wait any longer for good care.
Continue advocacy for fuller implementation of Early, Periodic Screening, Diagnosis and Treatment (EPSDT). Given the establishment of the EPSDT benefit as a compliance standard for parity in CHIP and concerns about how EPSDT is implemented, advocates can continue to encourage state regulators to monitor EPSDT services. Advocates can also proactively engage providers about the importance of including age-appropriate substance use disorders and mental health screenings as a critical component of the EPSDT benefit.
Push for more data, reporting, and enforcement. Laws and regulations do not guarantee robust enforcement. Advocates can urge state officials to improve data collection and reporting systems about consumer experiences, including better tracking of parity complaints with state agencies. Most importantly, advocates can press state and federal officials to enforce parity in all Medicaid and CHIP programs.
Many thanks to Community Catalyst for the content of this article.
The Ohio Department of Medicaid is finalizing plans to eliminate spend-down and redesign disability determinations. The Governor’s Office of Health Transformation published a white paper that discusses the plans in detail. UHCAN Ohio outlined some of the changes in our March newsletter. Spend-down will be eliminated, and qualifying for Medicaid will mean meeting the income limits. Ohio Department of Medicaid will provide different transitions for people depending on their situation, so it is important to watch for communications from the Ohio Department of Medicaid.
It is important that people who could have met spend-down to qualify for Medicaid (but did not do so) consider whether they could meet spend-down before the end of June. This applies to people who are 65 or older, have a disability, or are blind. Those who could meet the spend-down requirement before June should make sure to apply to Medicaid. Successfully qualifying for Medicaid reimbursement through spend-down, even for just one month, will help to provide you with benefits after July 1, 2016. If you can meet Medicaid spend-down but are not currently enrolled in Medicaid, contact your county Department of Jobs and Family Services or call the Ohio Department of Medicaid consumer hotline at 1-800-324-8680.
For the past 6 months, UHCAN Ohio has been working to organize consumers, advocates, and organizations to oppose the #NotHealthy4Ohio waiver. As a result of this work, approximately 100 advocates, activists, and other organizations filled the hearing room at the Ohio Department of Medicaid in Columbus to provide comments –all opposing – on the Healthy Ohio/#NotHealthy4Ohio Waiver. Of the 12 people who gave testimony, all of the 6 consumers that testified came in response to UHCAN Ohio’s call to action. All 12 people spoke out against the waiver. Click here to watch their testimony.
At the Cincinnati hearing, around 60 advocates attended. Of the 15 people who gave testimony, all of the 9 consumers that testified came in response to UHCAN Ohio’s call to action. Click here to watch their testimony.
On May 2nd, we launched a successful Thunderclap campaign telling Ohio Medicaid that forcing low-income Ohioans to pay for health coverage is #NotHealthy4Ohio. Many colleagues and consumers participated in the online action which reached over 97,000 people online.
We continue to organize people to write comments to Ohio Department of Medicaid before the May 16th deadline. If you have not already submitted comments, you still have time to do so. The open comment period ends on May 16, 2016. Please send the Ohio Department of Medicaid comments on the #NotHealthy4Ohio waiver and copy UHCAN Ohio at info@uhcanohio.org. We will use the comments you send to Medicaid to convince CMS to deny the waiver request.
For examples of comments, to share how you have benefitted from Medicaid coverage, and more, visit our resource center at www.uhcanohio.org/healthyohiomedicaidwaiver.
Report States Ohio To Experience Shortage Of Dentists – WYSO – 7/24/15
Health Briefs: Report highlights dentist shortage– LimaOhio.com – 7/27/15
