Summer 1997 - APA Column: A Victory for Child and Adolescent Mental Health

xxAACP Newsletter, Volume 11, Number 3, Summer 1997

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APA Column:
A Victory for Child and Adolescent Mental Health

Many community-based psychiatrists will find themselves on the delivery end of the new Child Health Insurance Program (SCHIP) signed into law in August by President Clinton as part of the balanced budget omnibus bill. Thanks to the lobbying efforts of the American Psychiatric Association and other members of the Coalition for Fairness in Mental Illness Coverage, and the staunch support of the Clinton Administration and key congressional allies, the new program contains coverage for mental illness despite objections from the Nation's governors.

Although the bill does not provide full parity in benefits, the APA estimates that almost all of the nearly two million children covered by the new program will receive some mental health coverage. As a bonus, however, the bill extends the Mental Health Parity Act of 1996 to the new program. The 1996 law requires parity for lifetime and annual caps between mental illness treatment and medical-surgical treatment benefits.

The new program, which becomes effective October 1, 1997, directs $24 billion in block grants to the states for purchasing health insurance for uninsured children. Considered perhaps the largest such program since the establishment of Medicaid in 1965, the new program becomes Title XXI of the Social Security Act.

Not to have included coverage of mental illness would have been tragic. Today there are an estimated 12 million children suffering from mental illness. Eight out of ten of those children do NOT receive the care they need. Compare that with the 74 percent -- nearly three out of every four children -- with physical handicaps who DO receive treatment. A major reason for these lopsided numbers is the lack of insurance coverage and discriminatory coverage where it does exist.

In order to receive Federal grant funds to operate a child health insurance program, States would have to enroll eligible children under their Medicaid programs, or else establish a health benefits package which includes one of the following four options:

A Benchmark Benefits Package: A State would have to offer currently uninsured children a health benefits package which is equivalent to either the Federal Employees Health Benefit Program Blue Cross/Blue Shield Preferred Provider Option; the health benefit program offered to State employees in the State; or the HMO health benefit program which has the largest commercial enrollment in the State.

A Benchmark Actuarial Equivalent Benefit Package: A State would have to offer a health benefits package which includes an actuarial equivalence to the aggregate value of a mandatory core of basic benefits (similar to the above Benchmark Benefit) and an actuarial value for mental health, vision, hearing, and prescription drug benefits (where included) of not less than 75% of the value of such additional benefits.

A Basic Benefit Package which is based on the State child health insurance benefits offered as of the date of enactment of the new federal law in either Florida, New York, or Pennsylvania.

A State Initiated Plan as approved by the Secretary of Health and Human Services.

Because the program technically starts October 1, 1997, implementation will be on a fast track. The problem is that because the extent of coverage varies from option to option in individuial states; there is no single option that can be said to be best in every state. Therefore, in order to assure that children get the broadest mental health coverage possible, state psychiatric associations and their allies including child advocacy groups must quickly develop and intensive lobbying campaign to persuade governors to choose the option in their state which offers the best mental health coverage.

The APA has commended the Clinton Administration and key bipartisan allies on Capitol Hill for their pivotal support for mental health coverage in the new program. In a letter to the President, APA Medical Director Melvin Sabshin, MD said, "We believe that your personal commitment to this historic investment in children's health care will make an important difference in the lives of children and working families. Also, we would like to express our deep appreciation to you for your personal efforts to fight for comprehensive benefits, which achieves the inclusion of mental health services in the benchmark benefits packages. We believe that this is an important first step on the journey toward ending insurance discrimination against people with mental illness."

Prepared by the Divison of Public Affairs and Division of Government Relations, American Psychiatric Association

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