Mental Health and Substance Use Parity

When it comes to expanding health care access, enacting legislation is critical, but barely half the battle. There is no better example than the struggle for fairness in insurance coverage for behavioral health care, or mental health and substance use parity. 

A number of years have elapsed since the 2008 federal Mental Health Parity and Addiction Equity Act and the 2000 Massachusetts Mental Health Parity Act became law. Yet, many consumers still find it more difficult to access mental health or substance use treatment than other types of health care because of insurance limits.

Legal Services

Health Law Advocates leads the way in Mental Health and Substance Use Parity advocacy in Massachusetts. Our Mental Health and Substance Use Parity Initiative starts with representing low-income clients denied access to mental health and substance use services. We’ve handled hundreds of such matters in recent years. One case involved “Stephanie”, a 52-year-old Lowell woman with major depression and breast cancer. Stephanie’s employer switched to a new out-of-state health insurer. The new insurer promptly denied coverage for a medication Stephanie had taken for years to treat her depression and infusions she was taking to treat her cancer. An HLA attorney quickly obtained coverage for the cancer treatment, but confronted substantial resistance from the insurer on coverage for the anti-depressant. Stephanie’s HLA attorney engaged in extensive negotiations with her health plan while preparing a formal appeal to challenge the denial. After a four-month dialogue, the health plan agreed to cover Stephanie’s medication without a formal appeal.       

Policy Advocacy

We also successfully advocate for landmark public policies to improve access to mental health and substance use services through more aggressive enforcement of the Parity laws. HLA is proud to lead the Massachusetts Mental Health and Substance Use Parity Coalition consisting of more than a dozen consumer and health care provider advocacy groups that fight for non-discriminatory insurance coverage together. The Parity Coalition won enactment of a 2012 state law requiring the Division of Insurance (DOI) and MassHealth to issue their first-ever regulations enforcing the Parity laws. We also worked together to secure pro-consumer provisions when these agencies wrote these regulations. On the national level, our Coalition has joined advocates from across the country in successfully advocating for additional consumer protections in federal law since the federal parity law was signed.     

Capacity Building

HLA also empowers consumers by educating the public about rights to access mental health and substance use services. We published a Parity Toolkit to help the public better understand the parity laws and what to do if you are denied access to treatment. We have held forums attended by hundreds of consumers, clinicians, attorneys, and other advocates throughout Massachusetts to increase awareness of the parity laws and how to use them to access care.

Mental Health Parity for Children

Securing insurance coverage for children’s mental health and substance use services poses unique challenges because children use different behavioral health services than adults. Our team works to help children unfairly denied insurance coverage for mental health and addiction services. We are grateful for the Nord Family Foundation’s and Boston Children’s Hospital’s support of this program.