Behavioral health services in separate CHIP programs on the eve of parity

Abstract

The Children's Health Insurance Program (CHIP) plays a vital role in financing behavioral health services for low-income children. This study examines behavioral health benefit design and management in separate CHIP programs on the eve of federal requirements for behavioral health parity. Even before parity implementation, many state CHIP programs did not impose service limits or cost sharing for behavioral health benefits. However, a substantial share of states imposed limits or cost sharing that might hinder access to care. The majority of states use managed care to administer behavioral health benefits. It is important to monitor how states adapt their programs to comply with parity.

Fig 1

Day/visit limits for behavioral health benefits in separate CHIP plans as of 2009. Note: Inpatient limits are measured in days/year; outpatient limits are measured in visits/year. States whose limits vary by income or plan (ID, IA, NJ, WI) were categorized by most generous limit in the state. Some states’ limits apply to combined MH/SA services (inpatient: NY, ND, WV; outpatient: NH, NY, NC, VA, WV) or combined BH/physical health services (PA). AR covers SA services only when the primary diagnosis is mental illness. “Other limit” includes: ME (2/3 h/week limit for outpatient MH/SA services); MS ($8000 limit on inpatient and outpatient SA per benefit period); MT ($6000/year & $12,000/lifetime limit on inpatient and outpatient SA); TX (12 weeks/year outpatient SA limit); VA (90 days/lifetime inpatient SA limit); WY ($6,000/year limit for combined inpatient/outpatient SA treatment). Source: Authors’ analysis of information collected from state policymakers, state CHIP plans, and state program/benefits information

Fig 2

Co-payments for behavioral health benefits in separate CHIP plans as of 2009. Note: In states where cost sharing varies by family income, highest possible cost sharing level is used to group state. “Full cost” indicates that service is not covered and families may face entire cost for services. Other cost sharing includes UT, where the highest income group pays 20% of total after deductible ($500 per child or $1,500 per family) for inpatient services. Source: Authors’ analysis of information collected from state policymakers, state CHIP plans, and state program/benefits information

Fig 3

Coverage of behavioral health services in separate CHIP programs, 2009. Source: Authors’ analysis of information collected from state policymakers, state CHIP plans, and state program/benefits information