The Mental Health Parity and Addiction Equity Act Evaluation Study: Impact on Mental Health Financial Requirements among Commercial “Carve-In” Plans

Abstract

Objective: Did mental health cost-sharing decrease following implementation of the Mental Health Parity and Addiction Equity Act (MHPAEA)?
Data source: Specialty mental health copayments, coinsurance, and deductibles, 2008-2013, were obtained from benefits databases for “carve-in” plans from a national commercial managed behavioral health organization.
Study design: Bivariate and regression-adjusted analyses compare the probability of use and (conditional) level of cost-sharing pre-and post-parity. An interaction term is addedt o compare differential levels of pre-and post-parity cost-sharing changes for plans that were and were not already at parity pre-MHPAEA.
Findings: Controlling for employer/plan characteristics, MHPAEA is associated with higher intermediate care copayments ($15.9) but lower outpatient ($2.6) copayments among in-network-only plans. Among plans with in-and out-of-network benefits, MHPAEA is associated with lower inpatient ($23.2)and outpatient ($2.5) copayments, but increases in inpatient and intermediate in-network and out-of-network coinsurance (about 1 percentage point). Among the few plans not at parity pre-MHPAEA, changes in use and level of cost-sharing associated with MHPAEA were more dramatic.
Conclusion: Mixed evidence that MHPAEA led to more generous mental health benefits may stem from the finding that many plans were already at parity pre-MHPAEA. Future policy focus in mental health may shift to slowing growth in cost-sharing for all health services.