More than one in four adult Americans without medical insurance have a mental illness or substance use disorder, or both, and are neglected by state healthcare initiatives for the uninsured, says a report by the National Alliance on Mental Illness and The National Council for Community Behavioral Healthcare.
Mental illness is the leading cause, and substance use is the second leading cause, of disability among adults, and approximately one-third of these groups that are living below the federal poverty line do not have insurance, according to data from the World Health Organization and the 2005 and 2006 National Survey on Drug Use and Health.
Cost is the reason that 80 percent of people who have a disorder do not seek mental health treatment, and it is also the reason that 34 percent of those who are insured do not seek treatment.
"Many states are trying to cover the uninsured but need to do more in these critical areas that affect one in four Americans," said NAMI Executive Director Michael J. Fitzpatrick.
"We can effectively treat substance use disorders and mental illnesses - and people that suffer from these debilitating conditions deserve treatment," added Linda Rosenberg, president and CEO of the National Council. "It is distressing that there are insurance plans and healthcare reform initiatives that continue to discriminate."
The scope of the benefit package for mental illness and substance use treatment varies greatly. Medicaid expansion programs generally provide a broad array of services, but some states impose limits on particular services or populations, the report found. For example, of the non-Medicaid plans, Minnesota's MinnesotaCare and General Assistance Medical Care programs have the most comprehensive outpatient benefit. Healthy New York and Pennsylvania's adultBasic program exclude treatment for mental illness and substance use disorders.
Based on a study of 18 states, approximately 60 percent have equal coverage for mental illnesses in initiatives for the uninsured, but only 28 percent include substance abuse.
Only five of the 18 states - Colorado, Indiana, Maine, Minnesota and Vermont - have parity or more benefits for substance abuse disorders in at least one of their programs or proposals for the uninsured.
The report says basic parity isn't enough, and that more states need to address problems with scope of benefits, utilization management, cost sharing and provider availability in their healthcare reform initiatives.
States that are closest to achieving universal coverage provide mental health parity as a component of their healthcare reform effort.
The report found that of the eight states that proposed or implemented programs for residents of all incomes, approximately 90 percent require mental health parity for serious mental illness or mental illness, while 40 percent provide parity for substance use disorders.
Of the proposals for universal healthcare expansions, only one, Colorado, had equal coverage for substance abuse and other health conditions.
States with varied levels of mental health and substance abuse benefits use federal waivers, but many of the programs with the broadest array of services and those closest to universal coverage receive federal waiver funds. The widespread use of federal waivers underscores the reliance on federal funds and the influence of the Center for Medicare and Medicaid Services' policy in furthering healthcare reform.
According to the report, legislative restrictions on federal waiver financing will also have an important impact on states' ability to move toward universal coverage.
A healthcare trend that is being reflected in state plans to cover the uninsured is increased cost sharing. The report revealed that, with few exceptions, these programs often have significant co-payments, including those targeting low income and small-employer populations.
According to the report, few states are including mental illness and substance abuse disorders in wellness and chronic disease management programs.
In your opinion, where does your state fall short in this area, and how could it boost its services? E-mail Associate Editor Molly Merrill at molly.merrill@medtechpublishing.com.