1. Parity: Necessary, but Insufficient for Mental Health Care Mike Hogan, Ph.D. Commissioner, NYS Office of Mental Health

2. 50% of the population: no lifetime mental illness 50%--some MI in lifetime 20-25%--some MI within any year 10-15%--mild impairment 5-7%-- moderate impairment 5-9% (Kids) 3-5% (Adults) Severe Impairment Who gets care: --25% of all those with MI --50% of those with moderate/severe MI Where care is given: General Health System Mental Health Specialists Publicly Financed System G M S A Framework: Where Does Parity Have an Impact? Patterns of Mental Illness and Mental Health Care

3. How Does Parity Relate? Coverage of People Receiving Care in NYS Public MH System (294k) (60k) (27k) (104k) (64k) (68k) (2005; n=615,417) Deep Benefit Parity Needed Coverage and Deep Benefit Needed

4. Why Parity is Necessary but Insufficient… 1.Equitable benefits are good if you have coverage, but dont help the uninsured –People with mental illness are disproportionately uninsured: Most coverage is employer based; unemployment is typical for people with SMI Onset of illness is frequently linked with transition off parents coverage

5. Why is Parity Insufficient? Not all plans are covered by parity requirements State mandates in 38+/- states have widely variable designs and apply only to state regulated plans ERISA pre-empts state regulation of self- insured plans and federal coverage requirements are weak Catastrophic and individual plans generally do not cover mental health treatment Medicares coverage is incomplete

6. Why is Parity Insufficient? Coverage under parity may still be limited –E.g. coverage of certain disorders, not others (as in NYSs Timothys Law, providing deep coverage for named disorders (e.g., schizophrenia, bipolar, ADHD) but not others (e.g. PTSD, eating disorders)

7. Why is Parity Insufficient? Your benefits exist, but you might not be able to access them –Under parity benefits, purchasers/insurers almost universally turn to managed care (enrollment up from 70M in 1993 to 164M in 2002) –Costs for mental health care in plans with generous benefits drop 30%-48% on conversion to managed caremostly inpatient reductions

8. Why is Parity Insufficient? Many care needs of those with SMI (adults) or SED (children) extend beyond what health care provides, e.g.: –Adults: housing, employment support, crisis respite, ACT? –Children/parents: parent coaching, residential treatment, respite, wrap-around services

9. How Could Health Reform Address These Limits? Toward universal coverage Coverage that bridges employer based policies, Medicare and Medicaid Deep benefit: Comprehensive collision coverage vs. coverage only of the deductible Integration of benefits/resources with the public system: Medicaid State hospitals, state subsidized services Fixed responsibility for care: Whos the $%#@?

10. Thank You