Addiction Medicine: Closing the Gap between Science and Practice

 Medicaid managed care plans* 87 and
benchmark/benchmark-equivalent plans†
that provide mental health/addiction
benefits; and

 State plans within the Children’s Health
Insurance Program (CHIP).^88

Under the law, plans that offer addiction
treatment benefits cannot impose limitations on
these benefits that are more restrictive than
limitations placed on medical and surgical
benefits.‡ 89

In addition to the federal parity laws, 49 states
and the District of Columbia have some type of
parity law for mental health services; at least 38
states include coverage addiction involving
alcohol and/or other drugs. While the scope of
these laws varies, some are stronger than
MHPAEA.§ 90

• This includes traditional and benchmark/benchmark

equivalent managed care plans. In Medicaid
benchmark/equivalent plans’ benefits are determined
by comparison to BlueCross/BlueShield, state
employee benefit plans, certain Health Maintenance
Organization (HMO) plans or benefits that include
the basic services defined in Section 1937(b)(2) of
the Social Security Act.
† The ACA extends certain MHPAEA parity

requirements to Medicaid benchmark and benchmark
equivalent plans that are not managed care plans that
provide mental health or addiction treatment benefits.
‡ The interim final regulations, which went into effect

on April 5, 2010, address how health plans must
comply with MHPAEA and how health plans may
define covered services that are consistent with
current medical standards. The regulations define
classification of benefits (such as inpatient, in-
network or prescription drug benefits); financial
requirements (such as deductibles and out-of-pocket
maximums); treatment limitations^ defined both
quantitatively (limits on day visits or frequency of
treatment limits) and qualitatively (standards for
provider admission into a network or prescription
drug formulary design); and how to determine
whether these restrictions comply with the law.
§ State parity laws generally fall into three categories:

(1) mental health parity/equal coverage laws in which
insurers must provide the same level of benefits for
addiction treatment as they do for other health
conditions; (2) minimum mandated mental health
benefit laws in which some coverage must be offered

A recent government evaluation found that post-

MHPAEA, 96 percent of employers’ plans

continued to offer both mental health and

addiction treatment services, two percent

continued to cover only mental health services

and another two percent discontinued their

coverage of addiction treatment services. Plans

also indicated that they had reduced service

limitations on addiction-related services after

MHPAEA. In general, patients’ average cost-

sharing burden declined after the MHPAEA,

with the exception of co-payments for office

visits which increased slightly.^91 (Table 8.1)

Analysis of national data found that in states

with broad parity laws (where benefits for the

treatment of addiction and mental illness are

mandated in at least some health plans and must

be offered at parity with medical and surgical

benefits), there was a 12.8 percent increase

but disparities in level of benefits provided are

permitted; and (3) “mandated offering laws” in which

an option of coverage for addiction treatment is

offered and, if coverage is accepted, benefits must be

equal with other health benefits.

Table 8.1

Employers’ Insurance Coverage of Addiction

Benefits Since Enactment of the MHPAEA

2008 Plan

Year

2010/2011

Plan Year

Employers including

addiction benefits in

most popular plan

97% 97%

Employers placing

limits on office visits

for addiction care

33% 8%

Employers placing

limits on inpatient

days for addiction care

27% 8%

Average office visit

copayment $25 $27

Average office visit

coinsurance 22% 19%

Average outpatient

services copayment $39 $33

Average outpatient

services coinsurance 26% 19%

Source: United States Government Accountability

Office. (2011).