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New Report Points to Barriers to Mental Health, Addiction Coverage

Today, Health & Medicine in collaboration with a group of organizations including the Kennedy Forum, the Illinois Psychiatric Society, the Community Behavioral Healthcare Association, and others who seek to improve mental health and addiction treatment released a new report pointing to significant barriers to coverage. The report highlights the results of a provider survey asking hospitals, psychiatrists and community providers about their experiences with reimbursement for mental health and addiction services. The survey findings raise red flags about a number of potential barriers to services that families may face and whether Illinois’ health plans are providing mental health and addiction treatment on par with other types of medical conditions, which is required by state and federal parity laws for most plans.

The report makes recommendations for policymakers, regulators, health plans, providers and consumers to ensure that Illinois residents have access to the services they need.

In response, State Representatives Steve Andersson, Deb Conroy, Sara Feigenholtz and Lou Lang have introduced a resolution to address these issues, HR 607. Rep. Conroy, chairwoman of the Mental Health Committee, has pledged to hold hearings.

Attorney General Lisa Madigan said, “This report raises important questions about whether consumers can access mental health and addiction insurance coverage when they need it. My office is committed to holding insurance companies accountable to our state’s mental health parity laws. Anyone who has problems with their health insurance coverage should contact my Health Care Bureau for help at 1-877-305-5145.”

The survey and report were conducted jointly by The Kennedy Forum Illinois, the Illinois Psychiatric Society, Illinois Association for Behavioral Health, IARF, the Community Behavioral Healthcare Association of Illinois, the Illinois Health and Hospital Association, and Health & Medicine Policy Research Group, and in partnership with members of the Illinois Parity Coalition.

Finding highlights:
  • Upwards of 75 percent of responding providers reported that Medicaid managed care organizations (MCOs) sometimes/often/always denied coverage for inpatient treatment, partial hospitalization, intensive outpatient treatment, and medication-assisted treatment. Nearly half of responding providers reported commercial insurers at least sometimes denied inpatient treatment.
  • More than 60 percent of responding providers reported that Medicaid MCOs sometimes/often/ always refused to cover the requested level of care and instead approved only a lower level of care, while 54 percent of responding providers reported commercial insurers did the same.
  • With Medicaid MCOs, nearly 65 percent of responding providers reported that they were told often or always that networks were simply closed. Nearly half of responding providers were told this often or always with commercial plans. The result: with mental health and addiction care providers unable to join plan networks, patients have more difficulty accessing care, due to the narrow network.
  • More than 90 percent of responding providers report that both Medicaid MCOs and commercial plans have refused to provide requested medical necessity criteria, despite clear legal requirements that plans do so.