Policy News Roundup: September 5, 2024

Barriers to mental health coverage

ProPublica investigated barriers to insurance coverage for mental health and protections that exist to help combat these barriers.

The problem: Although federal law (parity) requires insurers to provide the same access to mental and physical health care, insurers frequently restrict coverage and delay or deny care for mental illness. Insurers can set their own standards for determining what to pay for, and this is often determined by financial interests, rather than patient interests or clinical expertise.

What providers say: Interviews with hundreds of mental health providers found that many eventually decide to leave insurance networks, due to insurers interfering with patients’ care, the dysfunction of working with insurers, and it being financially unsustainable.

• It is often insurers, not therapists, that determine who can get treatment, what kind they can get, and for how long.
• More than a dozen therapists said insurers urged them to reduce care when their patients were on the brink of harm.
• Providers struggled to stay in business as insurers withheld reimbursements that sometimes came months late. Some spent hours a week chasing down the too-low payments.

States are implementing stronger protections, however:

• Many of the new protections in states are only just starting to be enforced, but a few states have begun punishing companies for violations and forcing them into compliance.
• 9 states have defined the clinical standards that insurers must use when making coverage decisions on mental health care. Some have also instituted medical necessity standards for substance use disorder treatment.
• In recent years, at least 24 states have passed legislation to try to regulate how insurers conduct utilization reviews of behavioral health care, which are often used by insurers as a pretext to dispute the necessity of treatment.
• Several states make insurers disclose to patients and providers the criteria or policies that they rely on for the reviews. Some states have also limited the frequency of reviews or dictate who can conduct the reviews.
• At least 31 states and DC have passed laws requiring insurers to report how much access they really provide to mental health care. Most ask insurers to provide details on their treatment criteria or limitations, but some states appear to be violating their own laws by not posting information publicly. The data and analyses that insurers submit may not be detailed or accurate.

Why it’s important: There are nowhere near enough available providers in insurance networks to serve all of the people seeking care, and even though almost all Americans are insured, many are unable to access care. Parity must be strengthened and enforced so that people with mental health/substance use disorder are able to access quality, affordable care, as determined by medical professionals, not insurers.

Surgeon General Murthy released an advisory on the mental health and wellbeing of parents, highlighting the urgent need to better support parents, caregivers, and families.

Why it’s important:

• Over the last decade, parents have been consistently more likely to report experiencing high levels of stress compared with other adults. They face unique stressors including demands of parenting, financial strain, time demands, concerns about children’s health and safety, parental isolation and loneliness, difficulty managing technology and social media, and cultural pressures.
• When stress is severe or prolonged, it can have a harmful effect on the mental health of parents and caregivers, which also affects the wellbeing of the children they raise.
• Children of parents with mental health conditions may face heightened risks for symptoms of depression and anxiety and for earlier onset, recurrence, and prolonged impairment from mental health conditions.
• Supporting parents/caregivers can also help prevent substance use among their children.

What it recommends: The advisory calls for a shift in culture, policies, and programs to ensure all parents/caregivers can thrive.

• Parents/caregivers should prioritize stress-relievers like exercise and enough sleep, along with recreational activities; nurture relationships with other parents, caregivers, or supportive friends; obtain insurance coverage for themselves and their families; and seek mental health care when needed.
• Employers should improve access to paid parental, medical, and sick leave, flexible work schedules, child care, and mental health care.
• Community leaders can foster social connections and support programs at libraries, faith-based organizations, barbershops, and schools.
• Health care providers can perform wellbeing checks for mental health conditions and economic/social needs during post-natal and pediatrician visits and provide links to care for parents who need support.

Read more: U.S. Surgeon General Issues Advisory on the Mental Health and Well-Being of Parents; Surgeon general’s new warning: Parents are stressed out

NIDA released the 2023 Monitoring the Future (MTF) survey results for adults.

What it found: In 2023:

• Marijuana use in the past year stayed at historically high levels among adults 19-30 and 35-50. Among adults 19-30, 42% reported cannabis use in the past year (highest among 23-24-year-olds), 29% in the past month, and 10% daily. Among adults 35-50, reports of use reached 29%, 19%, and 8%, respectively. For the first time in 2023, 19-30-year-old females reported a higher prevalence of past-year cannabis use than male respondents in the same age group.
• Delta-8 THC was included in MTF for the first time. More than 12% of adults 19-30 said they used Delta-8 in the past year, with the highest prevalence among those 21-22.
• Cigarette use in the past year remained at historically low levels in both groups.
• Alcohol use in the past year among adults 19-30 (84%) increased slightly over the past 5 years, but past-month (65%) and daily (4%) use continued a decade-long decline. Binge drinking (27%) reached all-time lows. However, among those 35-50, past-month use (69%) and binge drinking (27%) increased from 5 and 10 years ago, though daily drinking decreased over the past 5 years to record lows (8%). Alcohol remains the most-used substance.
• Vaping nicotine or cannabis in the past year among adults 19-30 remained at record highs (22% vaped cannabis and 25% nicotine in the past year, 14% and 19% in the past month).
• Hallucinogen use in the past year continued a 5-year steep incline, reaching 9% for those 19-30 and 4% for adults 35-50, historically high levels.
• Nonmedical use of prescription drugs in the past year and past-year use of opioid medications continued 5- and 10-year declines.
• Stimulant use in the past year has decreased for the past decade among adults 19-30 but has been increasing among adults 35-50.
• Psychedelic use hit a historic high, with nearly 9% of adults 19-30 and more than 4% of adults 35-50 reporting past-year use.

Read more: Cannabis and hallucinogen use among adults remained at historic highs in 2023

The problem: The public, including people who have lost loved ones to the opioid crisis or are dealing with it daily, are routinely shut out of having say in how opioid settlement funds can be best used.

Where it’s happening: In at least 39 states and DC, councils consisting of government officials, clinicians, law enforcement officials, and others guide decisions about how to spend the funds.

• At least 14 of these councils routinely block members of the public from speaking at their meetings.
• 4 of those typically conduct their meetings in secret, barring the public from attending or observing.
• Most councils do not make video recordings of their meetings readily available online. Some said recordings can be accessed through public records requests, but at least one deletes its recordings after using them to create meeting minutes.
• At least 5 states have used committees or work groups that meet in private, or have a policy for allowing private meetings.

Why it’s happening: States cited a variety of reasons for limiting public involvement.

• In some, state law does not require councils to take public comments at meetings.
• Several officials said they have sought feedback in other ways (e.g., public listening sessions).
• Some officials may worry that public comment would add to meetings that are multiple hours.

However: Several states manage concerns by limiting each person’s comment to a few minutes. Some states, like Illinois, Kentucky, Oregon, and Tennessee, routinely allow public comment and include people affected by the issue.

Read more: Public Voices Often Ignored in States’ Opioid Settlement Money Decisions