Abstract
The Children’s Health Insurance Program (CHIP) plays a vital role in financing behavioral health services for low-income children. This study examines behavioral health benefit design and management in separate CHIP programs on the eve of federal requirements for behavioral health parity. Even before parity implementation, many state CHIP programs did not impose service limits or cost sharing for behavioral health benefits. However, a substantial share of states imposed limits or cost sharing that might hinder access to care. The majority of states use managed care to administer behavioral health benefits. It is important to monitor how states adapt their programs to comply with parity.
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Notes
Both Medicaid and CHIP eligibility vary by state. Income eligibility is determined based on a family’s income relative to the federal poverty level (FPL), which was $22,050 for a family of 4 in 2009. In 2009, the median income eligibility cutoff for Medicaid was 185% FPL for infants, 133% FPL for children up to age 6, and 100% FPL for children up to age 19. In 2009, the median income eligibility cutoff for CHIP was 235% FPL for all children up to age 19. Eligibility limits ranged from a low of 160% FPL in North Dakota to 400% FPL in New York. (Ross et al. 2009).
Federal parity requirements are effective for plan years starting on or after October 4, 2009, which in most cases begin on January 1, 2010. Specific regulations implementing MHPAEA, published on February 2, 2010, were effective April 5, 2010 and apply to plan years beginning on or after July 1, 2010. CHIPRA guidance indicates that the federal government will not withhold funding from states “if States make a good faith effort to comply with the requirements prior to the issuance of any regulations or guidance implementing the provisions in question.” For example, states that require state legislation to adhere to the new law will not be penalized if their legislative schedule did not permit such a law to be passed prior to the federal implementation date.
For example, only four states have “comprehensive parity laws” that require coverage a broad range of mental health conditions, including substance use disorder services, and 26 states’ laws cover only “serious mental illnesses.”
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Acknowledgments
This research was supported by National Institute on Drug Abuse (Grant Nos. 1R01DA027414-01, K01DA019485, and 2K24DA019855).
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Some of the data in this manuscript were included in a poster presentation at the June 2010 Academy Health Annual Research Meeting in Boston, MA.
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Garfield, R.L., Beardslee, W.R., Greenfield, S.F. et al. Behavioral Health Services in Separate CHIP Programs on the Eve of Parity. Adm Policy Ment Health 39, 147–157 (2012). https://doi.org/10.1007/s10488-011-0340-5
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DOI: https://doi.org/10.1007/s10488-011-0340-5