A MATTER OF CIVIL RIGHTS

A Matter of Civil Rights

By Andrew Malekoff

Did you know that every day more than 290 Americans die from suicide or a drug overdose? With proper treatment, many of these tragedies could be prevented—but despite a law that guarantees coverage, people face enormous roadblocks when they seek care.

In 2008 President George W. Bush signed the landmark Mental Health Parity and Addiction Equity Act (Parity Act). The Parity Act mandates equal insurance coverage for mental health and substance use disorders (MH/SUD) as compared to other medical/surgical benefits covered by the plan.

According to its new website parityat10.com, “Parity at 10 seeks to ensure that insurance carriers and state Medicaid programs comply with the law so that consumers can access the evidence-based health care they need and are entitled by law to receive.”

What does equal insurance coverage mean? It means ending insurer discrimination against access to timely and affordable care including high out-of-pocket costs and shorter lengths of care for MH/SUD. Parity—which is another word for equity—in this case means that MH/SUD coverage must be provided on par with coverage of medical and surgical care.

Notably this legislation was the result of a bipartisan effort by Senators Paul Wellstone, a liberal Democrat, and Pete Domenici, a conservative Republican. What the senators had in common were personal family experiences that motivated their tireless efforts to pass this law.

Parity saves lives. Parity law is a civil rights law that has not been vigorously enforced by the States, which have the primary responsibility for enforcement of private insurance and Medicaid.

One of the most pernicious violations and barriers to care is inadequate networks of MH/SUD providers. North Shore Child & Family Guidance Center documented this in its 2018 Project Access Study which surveyed 650 Long Island consumers of MH/SUD care. Nearly 50% of respondents said that it was easier for them to access medical/surgical care than MH/SUD Care.

Nationally, patients responding to a National Alliance on Mental Illness (NAMI) survey reported being denied twice as often for mental health care as for medical surgical care under the Affordable Care Act.

The actuarial firm Milliman reviewed claims data in New York and found that patients had to go out-of-network for MH/SUD care far more often than for medical/surgical care—a very expensive proposition that flies in the face of the Parity Act.

At North Shore Child & Family Guidance Center, we are a proud partner of the Parity at 10 Compliance Campaign. On August 10 I attended an inaugural Parity at 10 meeting in Albany with my fellow advocates and top officials in the Cuomo administration.

Some of the details in this column were included in the policy brief provided to Governor Cuomo. The consensus among the advocates was that insurers do everything in their power to skirt parity.

Another staunch supporter of the original legislation was Patrick J. Kennedy, a former member of the U.S. House of Representatives. Kennedy struggled with mental illness and addiction for most of his life.

In his book A Common Struggle, Kennedy said the battle ahead is for the law to be enforced in the face of health insurers who stand to profit by denying the full range of coverage for people living with mental illness and addictions. Kennedy rightly frames the inequities that people with mental illness and addictions face as a matter of civil rights.

Discriminatory insurance coverage for those with mental health and substance use disorders must end. When insurers do not comply with the law and enforcement is inadequate, millions of Americans are at risk.

Andrew Malekoff is the Executive Director of North Shore Child & Family Guidance Center, which provides comprehensive mental health services for children from birth through 24 and their families. To find out more, visit www.northshorechildguidance.org.

This article appeared in TheIslandNow.com on August 16, 2018

HOW INSURERS ARE FAILING CHILDREN WITH MENTAL HEALTH NEEDS

http://nynmedia.com/news/how-insurers-are-failing-children-with-mental-health-needs

What happens when something that affects children’s lives is widespread but hidden in plain sight? What if it is something that creates untold heartache in lives that are already unnecessarily damaged? It should be addressed and corrected. Yet, because it is hidden from our collective consciousness it remains unaddressed, it persists, and this has consequences.

I am referring to the plight of countless middle-class families with children who have mental health and substance abuse problems and who have health insurance but cannot gain access to timely care.

Under a government mandate called network adequacy, commercial health insurers, used by many working, middle-class families, are required by license to offer adequate networks of providers (child psychiatrists, psychotherapists) for families confronting mental health and substance abuse problems. In other words, they are expected, as per their insurance plan, to provide ready access to a provider near where policyholders live. The reality, though, is that too often they do not.

Why? Because commercial health insurers that pay substandard reimbursement rates have too few in-network providers. Their low rates of reimbursement serve as a disincentive for providers, including community-based mental health agencies that should be providing universal access to care, to enroll in their networks. Consequently, many community-based agencies, along with those in private practice, will accept only higher paying Medicaid insurance.

The gap between reimbursement rates for commercial health insurance and Medicaid is vast. In some cases, for example, the rate paid to providers by commercial insurers is half the rate paid by Medicaid. Although a health insurer is expected to help families find an in-network provider, most often they do not. They simply give them a list of names, and few if any of those providers accept the insurance because the rates of reimbursement don’t come close to covering the cost of services. This then frustrates already anxious parents who have had to work up the courage to ask for help.

It is very difficult for a parent to pick up the phone and seek help when their child is suffering from mental illness or addiction. When they are repeatedly turned away by their supposedly in-network providers, who tell them “I no longer accept that insurance,” it is devastating. When a child is denied access to timely care for mental illness or addiction the results can be life-threatening. 

A few weeks ago a mother seeking mental health care for her teenager came to us at North Shore Child & Family Guidance Center and told a familiar story.

"It's very hard. Decent psychiatrists don't take new patients and the rest don't take our insurance. Most of them don't take your insurance," she said. The intake worker asked her how many turned her down before she called us. She said 20.

What needs to be done? The New York State Department of Financial Services, a relatively new state agency formed by Gov. Andrew Cuomo, has regulatory jurisdiction over insurance companies. However, in my experience, their inaction on this issue indicates that they do little, if anything, to monitor network adequacy.

Substandard rates of reimbursement (e.g. the gap between Medicaid and commercial insurance rates) may be considered a violation of the Affordable Care Act’s parity protections, which require health insurance companies to treat annual or lifetime dollar limits for mental health and substance abuse the same as they do medical benefits. If that is the case, the attorney general also has the power to address this matter if DFS will not. But what remedy is there if they do not take action?

The New York State Comptroller’s Office has the primary responsibility to ensure that state agencies such as DFS are using taxpayer money efficiently and effectively. If DFS does not investigate the issue of network adequacy, then they are open to the scrutiny of a state audit as it relates to their effectiveness in the use of taxpayer dollars to properly monitor insurance companies under their jurisdiction.

Although mental health legislation, The Helping Families in Mental Health Crisis Act, has been introduced in Congress, it will do little good if families cannot find a provider. The act will only work when the issue of access to care is monitored and enforced. It’s time for DFS to do its job and launch an investigation of any commercial insurance company suspected of not having an adequate network of providers. It could truly save lives.

Andrew Malekoff is the executive director of the North Shore Child & Family Guidance Center in Roslyn Heights, a nonprofit that provides comprehensive mental health services for children from birth through age 24 and their families. To find out more, visit www.northshorechildguidance.org. - See more at: http://nynmedia.com/news/how-insurers-are-failing-children-with-mental-health-needs#sthash.omFazlzp.dpuf

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FAMILIES CAN'T AFFORD TO WAIT FOR MENTAL HEALTH SERVICES

L.I. Business News, March 4, 2016 

Access delayed is access denied.

These are words that ring true for thousands of families across Long Island who have been unsuccessful in accessing timely and affordable mental health and addictions care through their health insurer.

How do I know this? From the stories that people tell us at North Shore Child & Family Guidance Center, a 63-year-old children’s mental health agency in Nassau County.

Health insurers are mandated by government to offer panels of providers so that families can find easily accessible, quality care for their loved ones; and not only for physical illnesses. This requirement is known as network adequacy, referring to adequate networks of care.

The problem of access for mental health care, however, is more complex and may begin with a family’s hesitance to ask for help and to reveal that they are living with someone who is suffering from a mental illness. Families coping with mental illness or addiction do not as readily seek help as they might for heart disease, cancer or diabetes. Why? Because of stigma and the shame it generates. When there is a mass shooting for example, and the perpetrator is labeled mentally ill, it casts a shadow on all people with mental illness, despite the fact that mentally ill persons are disproportionately the victims of violence.

In the United States we have chronically failed to treat illnesses above the neck the same as illnesses below the neck. For example, a parent who would not hesitate to reach out for help if their child was in an accident and appeared to have broken an arm, might wait weeks and months, if not longer, to ask for help if it was a mental health or substance abuse problem.

What makes all this so insidious is that once a parent picks up the phone to ask for help, and they are told repeatedly by providers, “I’m sorry I don’t accept that insurance any longer, I only accept cash,” there is a chance they will give up.

When a parent gives up, they risk their child deteriorating further. This is also true for adults with mental illness and increases the odds that they will ultimately need more costly care or confinement; hospitalization or incarceration.

What to do? Gov. Cuomo created the Department of Financial Services, charged with the responsibility to monitor private health insurers to ensure that they have adequate networks of care as a condition of their license. This means they must demonstrate the consistent ability to provide timely access to care for individuals and their families.

Just this week parents who came to the Guidance Center after taking their child to the emergency room, told us that they called no less than 20 different therapists or agencies and were turned down by all of them. Finally they called another hospital that made the referral to us. We turn no one away for inability to pay.

This is an all too familiar story that we hear frequently and that my colleagues from sister agencies tell me as well. You might wonder why this happening.

Private health insurers pay substandard rates of reimbursement for mental health and addictions care, as compared to Medicaid; sometimes 50 percent or less the than the Medicaid rate. Consequently, participating providers bail out because they cannot afford to accept such low rates. The insurers fail to carefully monitor their lists and the state fails to monitor and regulate the insurers.

In the case of delayed care for a child, this represents corporate and state child abuse.

I have reached out repeatedly to the governor, attorney general and numerous state legislators to issue a call to action to demand that DFS do their job. There is sympathy, but no action.

Andrew Malekoff is executive director of North Shore Child & Family Guidance Center in Roslyn Heights.

If you subscribe to Long Island Business News: http://libn.com/2016/03/04/malekoff-li-families-cant-afford-to-wait-for-mental-health-services/

A COMMON STRUGGLE

Patrick J. Kennedy is a former member of the U.S. House of Representatives who has struggled with mental illness and addiction for most of his life. He has become a leading force in the passage of the Mental Health Parity and Addiction Equity Act of 2008, a U.S. law that states that it is illegal to treat diseases of the brain differently than those of any other part of the body. The battle ahead is for the law to be enforced in the face of health insurers who stand to profit by denying the full range of coverage for people suffering with mental illness and addictions.

In his 2015 book, A Common Struggle: A Personal Journey Through the Past and Future of Mental Illness and Addiction, Kennedy offers personal reflections on the impact of trauma, addiction and mental illness on the extended Kennedy clan. He talks about the rocky relationship he had with his dad, the late U.S. Senator Edward “Ted” Kennedy and about his mom Joan’s battle with alcoholism.  

At the heart of the memoir are Kennedy’s own revelations about his co-occurring mental illness and prescription drug and alcohol addiction, his path to recovery, and his ascendance to becoming, arguably, the nation’s leading advocate for parity and equity in mental health and addiction care. Kennedy has fought hard to lift the veil of ignorance about mental illness and addiction and to expose the health insurance industry’s tradition of denying and restricting access to care for individuals with brain illness.

Kennedy radiates a fire for eradicating stigma and ending discrimination against people with brain illness. According to One Mind, a nonprofit organization he co-founded, that is dedicated to benefiting all affected by brain illness and injury, “One of the harmful effects of stigma is that it can lead to discrimination. It could be as obvious as someone making a negative remark about your mental illness or as subtle as someone avoiding you because they think you could be unstable, violent or dangerous.”

On their website, One Mind lists some of the ways that these attitudes can be damaging and even dangerous. For example:

·      Reluctance to seek help or treatment due to the labeling

·      Lack of understanding by family, friends, co-workers or others you know

·      Fewer opportunities for work, school or social activities or trouble finding housing

·      Bullying, physical violence or harassment

·      Health insurance that doesn't adequately cover your mental illness treatment

·      The belief that you'll never be able to succeed at certain challenges or that you can't improve your situation

Kennedy rightly frames the inequities that people with mental illness and addictions face as a matter of civil rights.

What he has accomplished, which he freely acknowledges is the result of a collective effort, has already gone a long way to wiping out stigma and increasing people’s access to mental health and addictions care. His goal, he states, is to launch “a new civil rights movement, to finally force medical equality for diseases of the brain.”

Tens of millions of Americans owe Patrick Kennedy a debt of gratitude for leading the way. Now all of us must carry the ball forward by treating children and adults with brain illnesses with dignity; and demanding that government enforce parity and equity for all and put an end to discrimination.

https://longislandweekly.com/a-common-struggle/ 

Andrew Malekoff is the Executive Director of North Shore Child & Family Guidance Center, which provides comprehensive mental health services for children from birth through 24 and their families. To find out more, visit www.northshorechildguidance.org.