MH Parity Mandate Added to SCHIP, Giving More Children Access to Care

President Barack Obama signed legislation last month that expands the State Children's Health Insurance Program (SCHIP) and includes provisions aimed at increasing mental health care, including for substance abuse, for millions of lower-income children.

Under the nearly $33 billion measure (PL-111-3), the number of children eligible for SCHIP will increase from 7 million to 11 million. Moreover, for the first time in its 12-year history, SCHIP will cover treatment for mental illnesses at the same rate and on the same terms as it does for nonpsychiatric disorders. The expansion becomes effective on April 1.

The measure also raises the maximum income of the families whose children can receive full matching funds from 200 percent of the federal poverty level to 300 percent, or $52,800 for a family of three.

The change thrilled mental health advocates.

“The American Psychiatric Association continues to fight for mental health equality, and we are especially pleased that this legislation includes strong language that will strengthen and improve access to mental health services, including substance abuse treatment services for children,” said APA President Nada Stotland, M.D. “Children's [good] mental health is essential to their well-being, and access to mental health care will enable children to play, learn, and grow into healthy adults.”

The measure eliminated the longstanding SCHIP provision that allowed states—which administer the program—to cover only 75 percent of the cost of mental health care included in benchmark plans that each state designates as models for SCHIP plans. The change requires that all private-sector SCHIP plans comply with the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, which requires parity coverage of psychiatric illness in employer-sponsored plans that offer mental health coverage.

Obama described the expansion of the program for the children of the working poor as the first step in his plan to overhaul the nation's health care system and expand access to insurance.

“Providing health care to more than 10 million children through the [State] Children's Health Insurance Program will serve as a down payment on my commitment to ensure that every American has access to quality, affordable health care,” Obama said in a written statement.

Coverage Hard to Find

The impact of the change in SCHIP is significant because research has found that while low-income children have much higher rates of mental illness than those in higher-income families, only about 40 percent of states offer full coverage of necessary services for children with complex psychiatric illnesses. Up to 20 percent of children and young adults may have a psychiatric illness at any given time, according to the Department of Health and Human Services, which estimates that the number of affected youth is between 7.7 million and 12.8 million. The department also estimates that two-thirds of all youth with mental illness are untreated. These children are at higher risk to fail at school, have poor employment prospects, have contact with the juvenile justice system, and are more vulnerable to suicide, according to David Shern, Ph.D., president and CEO of Mental Health America.

“Mental health care is a critical component of the range of services that children need for healthy development,” Shern said in a written statement.

Critics Blast Expansion

Opponents of the measure included former President George W. Bush, who twice vetoed nearly identical measures to expand SCHIP in 2007. Bush, like many other opponents, argued that the expansion would bring many privately insured children under the federal program, in part, because it provides federal matching funds for children from families whose income is up to 300 percent of the federal poverty level and are likely already insured. Some estimates have put the number of such children at about 2.4 million.

Many Republicans also complained that the measure expands coverage to include legal immigrant women who are pregnant and up to 600,000 children of legal immigrants. The previous law had set a five-year wait before children of legal immigrants could qualify for SCHIP coverage. Citizen children of illegal immigrants are eligible for SCHIP; however, illegal adult and child immigrants are eligible only for emergency care under Medicaid.

Democratic leaders countered that most Americans support SCHIP expansion and that it has become increasingly important as the economy worsens and more people lose their jobs.

Critics also objected to the expansion being funded by a 62-cent increase in the federal excise tax on cigarettes, which brings the total federal excise tax to $1.01 a pack. Opponents said cigarette taxes should go to smoking-cessation programs, not children's health care.

The federal funding for the program was set to run out on March 31, but the new law extends federal support for five years.

The SCHIP bill can be accessed by searching on HR 2 at<http://thomas.loc.gov>.▪