Amanda Bacon’s eating disorder was growing worse. She had lost 60% of her body weight and was consuming about 100 calories a day.
But that wasn’t sick enough for her Medicaid managed-care company to cover an inpatient treatment program. She was told in 2017 that she would have to weigh 10 pounds less – putting her at 5-foot-7 and 90 pounds – or be admitted to a psychiatric unit.
“I remember thinking, ‘I’m going to die,’ ” the Las Cruces resident recalled recently.
Eventually, Bacon, now 35, switched to a plan that paid for treatment, although she said it was still tedious to get services approved.
Many patients like Bacon struggle to get insurance coverage for their mental health treatment, even though two federal laws were designed to bring parity between mental and physical health care coverage. Recent studies and a legal case suggest serious disparities remain.
The 2008 Mental Health Parity and Addiction Equity Act required large group health plans that provide benefits for mental health to put that coverage on an equal footing with physical health. Two years later, the Affordable Care Act required small-group and individual health plans sold on the insurance marketplaces to cover mental health services and do that at levels comparable with medical services.
The laws have been partially successful. Insurers can no longer write policies that charge higher copays and deductibles for mental health care, nor can they set annual or lifetime limits on how much they will pay for it. But patient advocates say insurance companies still interpret mental health claims more stringently.
In February, researchers at the Congressional Budget Office reported that private insurance companies are paying 13% to 14% less for mental health care than Medicare does.
The insurance industry’s own data show a growing gap between coverage of mental and physical care in hospitals and skilled nursing facilities. For the five years ending in 2017, out-of-pocket spending on inpatient mental health care grew nearly 13 times faster than all inpatient care, according to inpatient data reported in February by the Health Care Cost Institute, a research group funded by the insurance companies Aetna, Humana, UnitedHealthcare and Kaiser Permanente.
In this environment, only half of the nearly 8 million children who have been diagnosed with depression, anxiety or attention deficit hyperactivity disorder receive treatment, according to a February research letter in JAMA Pediatrics.
Fewer than 1 in 5 people with substance use disorder are treated and, overall, nearly 6 in 10 people with mental illness get no treatment or medication.
Amanda Bacon, who is still receiving care for her eating disorder, remembers fearing that she wouldn’t get treatment. She was at one point rushed to an emergency room, but after several days was sent home, no closer to getting well.
Today, because of her disability, Bacon’s primary insurance is through Medicare, which has paid for treatment that her earlier Medicaid provider, Molina Healthcare, refused. She has been treated in four inpatient programs in the past two years – twice through Presbyterian Centennial Care, a Medicaid plan she switched to after Molina, and twice though her current Medicare plan. Bacon is also enrolled in a state-run Medicaid plan.
Molina said it could not comment on Bacon’s case. “Molina complies with mental health parity laws,” said spokeswoman Danielle Smith, and it “applies industry-recognized medical necessity criteria in any medical determinations affecting mental health.”
Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.