Behavioral health coverage: ACA marketplace plans come up short

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Though health insurers are stepping up their efforts to serve members with substance abuse and mental health problems, two new studies call into question the behavioral health coverage policies of Affordable Care Act marketplace plans.

One analysis, from the National Center on Addiction and Substance Abuse, found that more than two-thirds of states' 2017 benchmark plans contained obvious violations of the ACA's coverage mandates for addiction treatment benefits.

In addition, none of the plans provided comprehensive coverage for addiction treatment, 18 percent lacked compliance with parity requirements and documents for 88 percent of plans lacked sufficient detail about addiction treatment benefits.

Those coverage shortfalls may stem from the fact that, as detailed in a study published by Health Affairs, marketplace risk adjustment does not remove incentives for plans to limit coverage for services associated with mental health and substance abuse disorders.

Though risk adjustment is designed to mitigate adverse selection, the study's authors say their assessment points to "systemic underpayment" to plans for people with mental health and substance abuse diagnoses. These findings, they say, add to concerns that insurers are not complying with federal mental health coverage parity regulations.

Therefore, they suggest modifying the risk-adjustment formula--possibly by incorporating diagnosis codes used in the Medicare Part D risk-adjustment model.

The National Center on Addiction and Substance Abuse, meanwhile, urges states to revise their benchmark plans to both comply with parity laws and ensure comprehensive coverage of evidence-based addiction benefits without treatment limitations that harm patients.

"This will help to close the addiction treatment gap, improve the health of patients seeking addiction treatment and decrease costs for the health plans in the long-term," the group says.

To learn more:
- read the analysis
- here's the study (subscription required)