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States Falling Short In Plans To Cover Children

Discrimination against children with serious brain disorders may persist under the federal government’s landmark new health insurance plan for children, suggests a study examining existing mental health coverage in 16 states. Conducted by the Hay Group, a nationally recognized benefits consulting firm, for NAMI and its coalition partners, the study looked at the degree to which states are prepared to provide adequate mental health coverage under the State Child Health Insurance Program (SCHIP), which was passed by Congress last year.

Although all the states surveyed provide some level of coverage, states vary widely in actual mental illness benefits offered, the study found. No state plans are providing health insurance benefits for mental illnesses equal to those provided for physical illnesses. Essential services, including inpatient hospitalization and outpatient treatment, are not provided by every plan, nor are they provided at the same levels as services for other medical conditions.

NAMI is disturbed by study findings that many of these plans discriminate specifically against the most severely ill children. For example, one of the plans in Utah requires a 50-percent copayment after 10 days of inpatient treatment. In any given year, a child diagnosed with schizophrenia commonly requires more than 10 inpatient days. To qualify for federal funding under SCHIP, a state must provide health insurance coverage for uninsured children that is equivalent to one of three "benchmark" plans: the Federal Employees Health Benefits Plan; a state’s health plan for employees; or the largest health maintenance organization in the state. A state may also expand benefits provided under its Medicaid program or develop its own unique plan that is actuarially equivalent to any of the benchmark options.

NAMI plans to use the report findings to advocate at the state level for adequate and equitable health coverage for children with severe mental illnesses.

 

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