Mental Health

Approximately one in five Americans suffers from a mental disorder in any given year, yet many insurers fail to cover mental health services on the same basis as physical health services. (1) In fact, two in three adults with a diagnosed mental disorder do not receive treatment. (2) The Report Card examines three ways states can increase access to mental health care services. First, states can enact mental health parity legislation that requires private insurers to cover mental health disorders on the same basis as physical disorders. (3) Although federal legislation passed in 1996 offers some enhanced coverage, it does not require private insurers to provide full parity for mental health care services. (4) Second, states can cover eating disorders—90 percent of which involve adolescent or young adult women-on the same basis as other health conditions. These disorders have one of the highest death rates of any mental disorder. (5) Third, states can cover depression, which affects twice as many women as men, (6) on the same basis as other health conditions.

Data Points for this Issue:

  • Mental Health Parity

      Strength Of Policy 2007 Change From 2004
    ALABAMA No/Harmful Policy Same
    ALASKA No/Harmful Policy Same
    ARIZONA Weak Policy Same
    ARKANSAS Weak Policy Same
    CALIFORNIA Weak Policy Same
    COLORADO Weak Policy Same
    CONNECTICUT Meets Policy Same
    DELAWARE Weak Policy Same
    DISTRICT OF COLUMBIA No/Harmful Policy Same
    FLORIDA No/Harmful Policy Same
    GEORGIA No/Harmful Policy Same
    HAWAII Weak Policy Same
    IDAHO Weak Policy Better
    ILLINOIS Weak Policy Same
    INDIANA Limited Policy Same
    IOWA Weak Policy Better
    KANSAS No/Harmful Policy Same
    KENTUCKY Limited Policy Same
    LOUISIANA Weak Policy Same
    MAINE Limited Policy Better
    MARYLAND Meets Policy Same
    MASSACHUSETTS Weak Policy Same
    MICHIGAN No/Harmful Policy Same
    MINNESOTA Meets Policy Same
    MISSISSIPPI No/Harmful Policy Same
    MISSOURI Weak Policy Same
    MONTANA Weak Policy Same
    NEBRASKA Weak Policy Same
    NEVADA Weak Policy Same
    NEW HAMPSHIRE Weak Policy Same
    NEW JERSEY Weak Policy Same
    NEW MEXICO Limited Policy Same
    NEW YORK Weak Policy Better
    NORTH CAROLINA Weak Policy Same
    NORTH DAKOTA No/Harmful Policy Same
    OHIO Weak Policy Better
    OKLAHOMA Weak Policy Same
    OREGON Meets Policy Better
    PENNSYLVANIA No/Harmful Policy Same
    RHODE ISLAND Limited Policy Same
    SOUTH CAROLINA (1) Weak Policy Same
    SOUTH DAKOTA (2) Weak Policy Same
    TENNESSEE (3) Weak Policy Same
    TEXAS (4) Weak Policy Same
    UTAH (5) Weak Policy Same
    VERMONT Meets Policy Same
    VIRGINIA Weak Policy Same
    WASHINGTON Limited Policy Better
    WEST VIRGINIA Weak Policy Same
    WISCONSIN No/Harmful Policy Same
    WYOMING No/Harmful Policy Same
     
    Meets PolicyMeets Policy 5  
    Limited PolicyLimited Policy 6  
    Weak PolicyWeak Policy 28  
    No/Harmful PolicyNo/Harmful Policy 12  
    Better Better 7  
    Worse Worse 0  
    Same Same 44  
    • 1. South Carolina was graded incorrectly in the 2004 Report Card. It should have received a "weak policy" instead of a "no/harmful policy." Since there is no change in the individual state law for this state, the comparison with 2004 is based on the underlying data, that is, there is no change from 2004.
    • 2. South Dakota was graded incorrectly in the 2004 Report Card. It should have received a "weak policy" instead of a "no/harmful policy." Since there is no change in the individual state law for this state, the comparison with 2004 is based on the underlying data, that is, there is no change from 2004.
    • 3. Tennessee was graded incorrectly in the 2004 Report Card. It should have received a "weak policy" instead of a "no/harmful policy." Since there is no change in the individual state law for this state, the comparison with 2004 is based on the underlying data, that is, there is no change from 2004.
    • 4. Texas was graded incorrectly in the 2004 Report Card. It should have received a "weak policy" instead of a "no/harmful policy." Since there is no change in the individual state law for this state, the comparison with 2004 is based on the underlying data, that is, there is no change from 2004.
    • 5. Utah was graded incorrectly in the 2004 Report Card. It should have received a "weak policy" instead of a "no/harmful policy." Since there is no change in the individual state law for this state, the comparison with 2004 is based on the underlying data, that is, there is no change from 2004.

    Does the state have mental health parity legislation?

    States receive a "meets policy" if they have comprehensive laws requiring parity for all mental health problems and substance abuse. States that require parity with certain exceptions receive a "limited policy." States receive a "weak policy" if they have required parity for only a limited set of mental health problems (e.g., severe mental illness), for a limited population (e.g., state and local employees), or only for specific aspects of coverage (e.g., spending limits, out-of-pocket expenses). States receive a "no policy" if they have no mental health parity law.

    Data Source: Mental Health Parity, 2007.

    National Mental Health Association, "What Have States Done to Ensure Insurance Parity," unpublished data, current as of February 2007.

  • Eating Disorder Parity

      Strength Of Policy 2007 Change From 2004
    ALABAMA No/Harmful Policy Same
    ALASKA No/Harmful Policy Same
    ARIZONA Limited Policy Same
    ARKANSAS Meets Policy Same
    CALIFORNIA Meets Policy Same
    COLORADO No/Harmful Policy Same
    CONNECTICUT Meets Policy Same
    DELAWARE Meets Policy Same
    DISTRICT OF COLUMBIA No/Harmful Policy Same
    FLORIDA No/Harmful Policy Same
    GEORGIA No/Harmful Policy Same
    HAWAII No/Harmful Policy Same
    IDAHO No/Harmful Policy Same
    ILLINOIS No/Harmful Policy Same
    INDIANA No/Harmful Policy Worse
    IOWA No/Harmful Policy Same
    KANSAS No/Harmful Policy Same
    KENTUCKY Meets Policy Same
    LOUISIANA (1) No/Harmful Policy Same
    MAINE Meets Policy Same
    MARYLAND Meets Policy Same
    MASSACHUSETTS (2) Meets Policy Same
    MICHIGAN No/Harmful Policy Same
    MINNESOTA Meets Policy Same
    MISSISSIPPI No/Harmful Policy Same
    MISSOURI Limited Policy Same
    MONTANA No/Harmful Policy Same
    NEBRASKA Limited Policy Better
    NEVADA No/Harmful Policy Same
    NEW HAMPSHIRE Meets Policy Same
    NEW JERSEY Limited Policy Better
    NEW MEXICO Meets Policy Same
    NEW YORK Meets Policy Better
    NORTH CAROLINA Limited Policy Same
    NORTH DAKOTA No/Harmful Policy Same
    OHIO No/Harmful Policy Same
    OKLAHOMA No/Harmful Policy Same
    OREGON Meets Policy Better
    PENNSYLVANIA No/Harmful Policy Same
    RHODE ISLAND Meets Policy Same
    SOUTH CAROLINA No/Harmful Policy Worse
    SOUTH DAKOTA No/Harmful Policy Same
    TENNESSEE Limited Policy Same
    TEXAS No/Harmful Policy Same
    UTAH Limited Policy Same
    VERMONT Meets Policy Same
    VIRGINIA No/Harmful Policy Same
    WASHINGTON Meets Policy Better
    WEST VIRGINIA Meets Policy Better
    WISCONSIN No/Harmful Policy Same
    WYOMING No/Harmful Policy Same
     
    Meets PolicyMeets Policy 17  
    Limited PolicyLimited Policy 7  
    Weak PolicyWeak Policy 0  
    No/Harmful PolicyNo/Harmful Policy 27  
    Better Better 6  
    Worse Worse 2  
    Same Same 43  
    • 1. Louisiana was graded incorrectly in the 2004 Report Card. It should have received a "no/harmful policy" instead of a "meets policy." Since there is no change in the individual state law for this state, the comparison with 2004 is based on the underlying data, that is, there is no change from 2004.
    • 2. Massachusetts was graded incorrectly in the 2004 Report Card. It should have received a "meets policy" instead of a "no/harmful policy." Since there is no change in the individual state law for this state, the comparison with 2004 is based on the underlying data, that is, there is no change from 2004.

    Does the state require private insurers to cover treatment for eating disorders on the same basis as other mental health conditions?

    States that require insurers to cover anorexia and bulimia on the same basis as other mental health conditions receive a "meets policy." States that require coverage in a limited way (i.e., they only require coverage for certain populations or they contain exemptions) receive a "limited policy." Those states with no such laws or laws that do not require coverage of anorexia and bulimia receive a "no policy."

    Data Source: Eating Disorder Parity, 2007.

    Data provided by Mental Health America, unpublished, current as of February 2007.

  • Depression Parity

      Strength Of Policy 2007 Change From 2004
    ALABAMA No/Harmful Policy Same
    ALASKA No/Harmful Policy Same
    ARIZONA Limited Policy Same
    ARKANSAS Meets Policy Same
    CALIFORNIA Meets Policy Same
    COLORADO Meets Policy Same
    CONNECTICUT Meets Policy Same
    DELAWARE Meets Policy Same
    DISTRICT OF COLUMBIA No/Harmful Policy Same
    FLORIDA No/Harmful Policy Same
    GEORGIA No/Harmful Policy Same
    HAWAII Meets Policy Better
    IDAHO Limited Policy Better
    ILLINOIS Meets Policy Better
    INDIANA No/Harmful Policy Worse
    IOWA Meets Policy Better
    KANSAS No/Harmful Policy Same
    KENTUCKY Meets Policy Same
    LOUISIANA Meets Policy Same
    MAINE Meets Policy Same
    MARYLAND Meets Policy Same
    MASSACHUSETTS Meets Policy Same
    MICHIGAN No/Harmful Policy Same
    MINNESOTA Meets Policy Same
    MISSISSIPPI No/Harmful Policy Same
    MISSOURI Limited Policy Same
    MONTANA Meets Policy Same
    NEBRASKA Meets Policy Same
    NEVADA Meets Policy Same
    NEW HAMPSHIRE Meets Policy Same
    NEW JERSEY Meets Policy Same
    NEW MEXICO Meets Policy Same
    NEW YORK Meets Policy Better
    NORTH CAROLINA Limited Policy Same
    NORTH DAKOTA No/Harmful Policy Same
    OHIO Meets Policy Better
    OKLAHOMA Meets Policy Same
    OREGON Meets Policy Better
    PENNSYLVANIA No/Harmful Policy Same
    RHODE ISLAND Meets Policy Same
    SOUTH CAROLINA Meets Policy Better
    SOUTH DAKOTA Meets Policy Same
    TENNESSEE Limited Policy Same
    TEXAS Meets Policy Same
    UTAH Limited Policy Same
    VERMONT Meets Policy Same
    VIRGINIA Meets Policy Same
    WASHINGTON Meets Policy Better
    WEST VIRGINIA Meets Policy Better
    WISCONSIN No/Harmful Policy Same
    WYOMING No/Harmful Policy Same
     
    Meets PolicyMeets Policy 32  
    Limited PolicyLimited Policy 6  
    Weak PolicyWeak Policy 0  
    No/Harmful PolicyNo/Harmful Policy 13  
    Better Better 10  
    Worse Worse 1  
    Same Same 40  

    Does the state require private insurers to cover treatment for depression on the same basis as other mental health conditions?

    States that require insurers to cover depression on the same basis as other mental health problems receive a "meets policy." States receive a "limited policy" if they require such coverage but in a limited way (i.e., they only require coverage for certain populations or they have exemptions). States that do not have any such laws or have laws that do not require coverage of depression receive a "no policy."

    Data Source: Depression Parity, 2007.

    Data provided by Mental Health America, unpublished, current as of February 2007.

1. A "mental disorder" is "a health condition marked by an alteration in thinking, mood, or behavior (or some combination thereof) that is associated with distress and/or impaired functioning." U.S. Department of Health and Human Services, Mental Health: A Report of the Surgeon General (Rockville: U.S. Department of Health and Human Services, National Institute of Mental Health, 1999), 227.

2. Ibid., at  408, 418.

3. Ibid., at 426.

4. The Mental Health Parity Act of 1996 prohibits all health plans that offer mental health benefits from setting lower lifetime and annual dollar limits on mental health benefits than any similar dollar limits for medical and surgical benefits, with a few exceptions. The Act does not apply to benefits for substance abuse or chemical dependency, it does not apply to employers with fewer than 51 employees, and any group health plan whose costs increase one percent or more due to application of the law can claim an exemption from it. 29 U.S.C. § 1185a, 42 U.S.C. § 300gg-5.

5. U.S. Department of Health and Human Services, Healthy People 2010, 2nd ed. (Washington: U.S. Department of Health and Human Services, 2000), 18-8, available at http://www.health.gov/healthypeople.

6. This disparity is true for major depression, anxiety disorders, and mood disorders. U.S. Department of Health and Human Services, Mental Health: A Report of the Surgeon General (Rockville: U.S. Department of Health and Human Services, National Institute of Mental Health, 1999), 225-226.