EDC Survey of Benchmark Plans

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Beginning on January 1 2014, the Affordable Care Act (ACA) requires that all (non-grandfathered) individual and small group health insurance plans sold in a state cover certain essential health benefits (EHB’s). In January 2013, the Eating Disorders Coalition (EDC) surveyed all of fifty states and the District of Columbia’s proposed benchmark plans and discovered a wide disparity in the anticipated mental health service coverage between states. 

Executive Summary

There exists a wide disparity in anticipated mental health and substance abuse service coverage between states, particularly as it relates to residential care and eating disorder care.  This troubling disparity is of great concern for people struggling with eating disorders and other mental health and substance abuse issues across the country.

According to our survey, twenty-seven of the benchmark plans severely limit mental health services. Seventeen of these plans have day limits on mental health services and nine states have exclusions for residential services. In some cases, the states with limits on mental health do not have the same limits on substance abuse services; in other cases limits are extreme for both mental health and substance abuse. Given that similar limits are not seen in medical services, the disparity on quantitative day limits and unequal exclusionary status should not be allowed under Mental Health Parity.

In contrast, our review indicates that twenty-four states have strong mental health coverage, without non-equitable service limits. Vermont has the strongest coverage for eating disorders and Connecticut, Idaho, and Maine also having very strong plans.  

With half of the states including equitable coverage for mental health and substance abuse services, there is strong evidence that plans can and do include equitable and inclusive treatment for mental health and substance abuse. There is a pressing need for the other half of the nation to provide for inclusive coverage of these illnesses. As the benchmark plans are implemented, it is imperative that states offer equitable and adequate access to care for people suffering with mental health conditions, including eating disorders. It is also imperative that all Benchmark plans follow Mental Health Parity.  We urge advocates to monitor and influence the implementation in their states, specifics for each state can be found at http://healthreform.kff.org/state-exchange-profiles-page.aspx.

Download the entire document here.