OHS Releases Study Assessing Behavioral Health Parity in Connecticut

(Hartford, CT) - Behavioral health disorders impact a growing number of children and adults in Connecticut and across the country. About one in five adults (20%) in Connecticut experienced a mental health disorder in 2021. Nearly 500,000 individuals ages 12 years or older had a substance use disorder that year. Drug overdoses increased from 11.2 to 42.3 per 100,000 population from 2011 to 2021, exceeding the national average of 32.4 per 100,000. As of June 2023, 1.54 million state residents lived in mental health workforce shortage areas. Connecticut, like many states, faces challenges in meeting increased community need for accessible, high-quality and affordable behavioral health services.

The Connecticut Office of Health Strategy (OHS), working collaboratively with the state Departments of Children and Families, Mental Health and Addiction Services and Social Services, recently published the Behavioral Health Insurance Coverage and Payment Parity in HUSKY, Private Insurance and Medicare Advantage final report and presentation. The report, and related behavioral healthcare workforce environmental scan, presents the findings of a study conducted to assess the impact of specific factors impacting the accessibility of behavioral health services. The study examined the following questions pursuant to Public Act 22-47 §§ 57-58 utilizing 2022 rate and service delivery data:

• What are health care providers paid for covered physical, mental and behavioral health services?

• Does parity exist between payments for behavioral health and payments for medical services across payers including Medicaid (HUSKY), commercial insurance and Medicare Advantage?

• How does payment parity impact the behavioral health workforce?

The study found that HUSKY (Connecticut Medicaid) 2022 reimbursement rates were lower than benchmarks for both physical and behavioral health services. No disparities were found between the 2022 rates for physical and behavioral health - rates were comparably low across service types.

"Connecticut recognizes the importance of high-quality, accessible behavioral health services and has taken steps to increase behavioral health reimbursement rates for children and young adults," said Deidre Gifford, MD, MPH, OHS Commissioner. "The Department of Social Services has been proactive in meeting the needs of children and families enrolled in HUSKY."

"We've prioritized the needs of children and adolescents who need access to quality behavioral health services, investing an additional $29.3 million over two years," said Andrea Barton-Reeves, Commissioner of the Department of Social Services. "This work is about more than dollars and cents-it's about improving lives, supporting our providers, and building a stronger, healthier Connecticut."

Connecticut Medicaid rates for behavioral health services for individuals age 20 and under were increased pursuant to Public Act 23-204 §1 through a state plan amendment effective July 1, 2024 to help bring the state up to the benchmark. These increases represent an estimated additional aggregate expenditure of $13.8 million in state fiscal year 2025 and $15.5 million in state fiscal year 2026.

The analysis did identify disparities in some areas based on the 2022 data:

• Medicare Advantage rates for psychiatry were lower than for other physician specialties, suggesting rates for physician provided behavioral health services are not in parity with physician-provided medical services.

• Four commercial insurers - Anthem, Cigna, Connecticare, and United Healthcare - had evidence of disparities between behavioral health and other medical service rates.

The study identified trends in service utilization. Individuals with Medicaid coverage utilized inpatient and emergency department services for behavioral health needs at higher rates than individuals with commercial insurance in 2022. Outpatient treatment utilization for mental health disorders was similar for individuals with Medicaid (79%) versus individuals with commercial insurance (77%), however commercially insured individuals (63%) accessed substance abuse outpatient treatment services at a much lower rate than Medicaid recipients (77%). Individuals with Medicare Advantage coverage utilized outpatient behavioral health services at a lower rate for both mental health disorders (54%) and substance use disorders (57%). The study only assessed services reimbursed by a healthcare payer and does not include self-pay services.

The study also included an environmental scan of the behavioral health workforce in Connecticut. The scan assessed existing capacity of the state's behavioral health workforce to meet growing community need. Based on 2022 data, Connecticut had fewer behavioral health providers, and particularly fewer psychologists and social workers, than some neighboring states such as Massachusetts and Vermont (per 100,000 total state population). There were also fewer behavioral health providers participating in Medicaid than in commercial insurance plans.

"Addressing payment parity, by ensuring behavioral healthcare providers receive payment rates comparable to their physical health providers, is one important piece of a complex issue," said Gifford. "The data, and the literature, tell us that no one solution will address the gap between need for care and accessible services or service providers. Peer support, telehealth, crisis care and school-based healthcare among other approaches, merit further exploration as well."

The report, presentation of report findings and environmental scan are available to the public on the OHS website.

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