Healthcare: Access, Medicaid and Mental Health

As part of our Future of Healthcare series, Steve Adubato and John Jacobi, Professor of Health, Law and Policy at Seton Hall Law School, discuss problems with getting access to appropriate care, issues within the Medicaid system and the state’s regulatory structure to treat mental and substance abuse disorders in a primary care setting.

12/15/18 #231

Excerpt:

"State of Affairs is pleased to welcome John Jacobi, Professor of Health Law & Policy at Seton Hall Law School Good to see you John. Good to see you. Thank you. One of the areas you focus on is the question of parity when it comes to healthcare payment. What does that mean? The parity movement has been around for 20 or 25 years. Is it a movement? The first big federal bill was passed in 1996. The idea behind mental health parity is that coverage for mental health services should be on parity, should be the same essentially, as coverage for physical health services. By the way, before we go any further, I want to... I should have clarified, this is part of our ongoing series on the future of healthcare, and the question of parity in terms of what's paid for and what's not is a huge part of the future, right? It is. It is. For a couple of reasons. Go ahead. One, because there has been problems in New Jersey and elsewhere of people with mental health issues getting access to appropriate care, and the second thing is that as we move to an integrated healthcare delivery system, where physical health and mental health occur in the same place, we don't want there to be confusion over what's paid for and what's not. So hold on one second. Are we saying that if you seek and receive mental health services, that insurance companies and others, the government as well, don't look at it the same as if you have a broken arm? Sometimes yes, sometimes no. There's low-hanging fruit that's been picked off. So insurance companies have worked pretty hard in response to federal legislation and state legislation, to be on the right side of the law here. And what they've done well, I think, more or less, is to make sure that there aren't payment limits, that is... Like a cap? A cap. A cap on the number of visits or on lifetime expenditures for mental health services, insurance companies have done quite a good job with that. Here's the problem that arises still. And it's conceptually quite a difficult problem. And that is that, at times, insurance companies will deny coverage, because they will assert the coverage is not medically necessary. And insurance companies can do that. They can review a doctor's order, and determine whether it's medically necessary or not. Mental health parity requires that the process that insurance companies go through be identical, or on parity for physical health and mental health services. Sometimes it's not. I'm curious..."