Mental Health Coverage Individual Market - Kaiser State Health Facts

State Mandated Benefits in the Individual Private Health Insurance Market: Mandated Coverage in Mental Health, as of January 2009

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	State Mandate of Mental Health Coverage?			Detail on Minimum Mental Health Benefit Requirements					Detail on Mental Health Parity Requirements
	Any Kind of Coverage Required?	Mandate to Offer or to Cover?	Requirement Limited to BBMI or SMI?	Minimum Mental Health Benefits Specified?	Outpatient Visits	Inpatient Days	Rx Required?	Other?	Parity Required?	Full/Limited?	Limited to BBMI or SMI?

United States	22+DC Yes	NA	9 Yes	10+DC Yes	NA	NA	0 Yes	NA	14 Yes	NA	9 Yes

Alabama	No	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA
Alaska	No	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA
Arizona	No	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA
Arkansas	Yes	Offer	No	No	NA	NA	NA	NA	Yes	Full	No
California	Yes	Cover	Yes	No	NA	NA	NA	NA	Yes	Full	Yes
Colorado	No	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA
Connecticut	Yes	Cover	No	No	NA	NA	NA	NA	Yes	Full	No
Delaware	Yes	Cover	Yes	No	NA	NA	NA	NA	Yes	Full	Yes
District of Columbia	Yes	Cover	No	Yes	75% coverage for 1st 40 visits, then 60% coverage	60 days a year	No	No	No	NA	NA
Florida	No	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA
Georgia	Yes	Offer	No	Yes	48 Visits	30 Days	No	No	No	NA	NA
Hawaii	Yes	Cover	No	Yes	30 Visits	30 Days	No	Nondiscrimation in cost sharing	Yes	Full	Yes
Idaho	No	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA
Illinois	No	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA
Indiana	No	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA
Iowa	No	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA
Kansas	Yes	Cover	No	Yes	Not Defined	30 days	No	$7,500 lifetime benefit limit	No	NA	NA
Kentucky	No	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA
Louisiana	No	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA
Maine	Yes	Cover	Yes	No	NA	NA	NA	NA	Yes	Limited	Yes
Maryland	Yes	Cover	No	Yes	80% coverage for 1st 5 visits, 65% coverage for visits 6-30, 50% coverage for visits 31+	Parity for inpatient care; 60 days for partial hospitalization	No	Nondiscrimation in cost sharing	No	NA	NA
Massachusetts	Yes	Cover	No	Yes	24 Visits	60 days a year	No	No	Yes	Limited	Yes
Michigan	No	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA
Minnesota	No	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA
Mississippi	Yes	Offer	No	Yes	52 Visits	30 days for inpatient, 60 days for partial hospitalization	No	Outpatient care may be limited to 50% cost sharing or $50 per visit.	No	NA	NA
Missouri	Yes	Offer	Yes	Yes	Parity	90 days	No	Nondiscrimation in cost sharing	No	NA	NA
Montana	Yes	Cover	Yes	No	NA	NA	NA	NA	Yes	Full	Yes
Nebraska	No	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA
Nevada	Yes	Cover	Yes	Yes	40 Visits	40 Days	No	OOP limits must be no more than 150% of OOP limit set for medical benefits	No	NA	NA
New Hampshire	No	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA
New Jersey	Yes	Cover	Yes	No	NA	NA	NA	NA	Yes	Full	Yes
New Mexico	No	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA
New York	No	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA
North Carolina	No	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA
North Dakota	No	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA
Ohio	Yes	Cover	Yes	No	NA	NA	NA	NA	Yes	Limited	Yes
Oklahoma	No	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA
Oregon	No	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA
Pennsylvania	No	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA
Rhode Island	Yes	Cover	No	No	NA	NA	NA	NA	Yes	Limited	No
South Carolina	No	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA
South Dakota	Yes	Cover	Yes	No	NA	NA	NA	NA	Yes	Full	Yes
Tennessee	No	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA
Texas	No	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA
Utah	No	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA
Vermont	Yes	Cover	No	No	NA	NA	NA	NA	Yes	Full	No
Virginia	Yes	Cover	No	Yes	20 visits, after the 1st 5 visits, coverage may be limited to 50%	20 Days	No	No	No	NA	NA
Washington	Yes	Cover	No	No	NA	NA	NA	NA	Yes	Limited	No
West Virginia	Yes	Offer	No	Yes	50% coverage up to $500 per year	Parity for inpatient care at a medical hospital or 45 days in mental health department of hospital or in a mental hospital	No	No	No	NA	NA
Wisconsin	No	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA
Wyoming	No	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA

(show/hide notes)

Notes:

Data as of January 2009.

Under federal law, there is no mandate for group health plans to provide coverage for the treatment of mental illness. However, if a group health plan does offer mental health benefits, they must have parity with medical benefits. In October of 2008, the Mental Health Parity Act was amended (to go into effect in October 2009) to expand parity to the treatment of substance abuse and to expand the definition of parity to include financial requirements and treatment limitations. Under the amendments, group health plans that offer mental health benefits and substance abuse treatment benefits must ensure parity with regards to annual and lifetime benefit limitations, as well as cost sharing, including copayments and coinsurance. Small employers are exempt from these requirements.

Sometimes, state law requires health insurance plans sold by licensed insurers to include coverage for a specific benefit. This is called a "mandate to cover." As an alternative, a state law may require health insurers to offer coverage for a specific benefit, but the person or group buying the policy does not have to elect coverage for that specific benefit. This is a "mandate to offer."

States that require insurers to cover mental health benefits on the same basis as other medical benefits, with regard to both benefit levels and cost sharing receive Parity. States that require insurers to cover mental health benefits on the same basis as other medical benefits, only with regard to either benefit levels or cost sharing, but not both, receive Limited Parity. States that required coverage of mental health benefits, but do not require parity, receive Minimum Benefit Standard.

Sources:

Data compiled through review of federal and state law and interviews with government regulators. Data collection and analysis by researchers at the Health Policy Institute, Georgetown University.

Definitions:

"BBMI" refers to biologically based mental illness, and "SMI" refers to severe mental illness, two terms used under some state's laws. These terms typically include conditions such as major depressive disorder, schizophrenia, and bipolar disorder.

NA: Data are not available.

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