Mandated Mental Health Benefits for Children

Part 2 (Continued from the May 1 issue)

A study by the U.S. Department of Health and Human Service's Office of Managed Care, Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, indicates that parity would increase premiums by an average of 3.6 percent, and such increases would be higher for plans that are limited to coverage of children. The study estimates that parity in plans funded by the Children's Health Insurance Program (CHIP) would likely increase premiums more than in plans that cover adults, though the differences would be minimal in a managed care setting.

At least five states are considering legislation mandating some form of mental health coverage for children by health insurers. Two bills have been filed in the Texas Legislature this session that would mandate children's mental health coverage. Texas House Bill 1406 would require health benefit plans to cover persons under age 19 for treatment of serious mental illness. Texas House Bill 1650 would require health benefit plans to cover self-inflicted injuries for persons up to age 18 who have a serious mental illness or who have tried to commit suicide.

The other states' bills (California AB 88 and SB 468, Maine HB 835, Missouri HB 894, SB 338, and Virginia SB 430) differ from the Texas bills because they do not apply exclusively to children, but instead provide more extensive coverage for children than for adults.

The California bills would require health care service plans to provide coverage for the diagnosis and necessary treatment of "mental disorders and illnesses" of a person of any age and of an additional category of disorders, "serious emotional disturbances," of a child.

Maine HB 835 would provide for coverage of certain listed mental illnesses and includes a separate provision applying to children up to 18 years of age, which covers additional mental health conditions.

Missouri's bills require that plans offer coverage of recognized mental illnesses. The individual or group policyholder can decline such coverage, but if coverage is declined, plans must provide certain specified minimum catastrophic mental health coverage. Such catastrophic coverage includes: 1) for children up to age 18, a diagnosable mental, behavioral, or emotional Axis I disorder resulting in functional impairment which interferes substantially with the child's functioning in family, school, or community activities; and 2) for adults, a diagnosable mental, behavioral, or emotional Axis I disorder resulting in functional impairment which interferes substantially with one or more of the adult's major life activities.

Virginia SB 430 provides that health maintenance organizations shall provide coverage for biologically based mental illnesses, including a list of disorders, which covers, for example, attention deficit hyperactivity disorder and serious emotional behavioral disorders in children.

- Melanie R. Margolis, Research Professor

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©2006 Texas Medical Center

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