Under a new state law that went into effect late last month, Missouri will become the final state to enforce a federal law designed to ensure mental health care is covered by insurance providers the same as treatments for physical ailments.

The provisions were included in House Bill 604, an omnibus insurance bill sponsored by Rep. Kurtis Gregory, R-Marshall, that was signed into law by Gov. Mike Parson in July. The provisions enforcing the federal law will apply to insurance providers starting Jan. 1, 2022.

Initially filed as standalone bills by Kansas City Democrats Sen. Greg Razer and Rep. Patty Lewis, the measures codify in state statute that health insurance plans must meet the requirements of the Mental Health Parity and Addiction Equity Act of 2008.

Signed into law by former President George W. Bush, the landmark federal law stipulated that health insurance plans cannot impose dollar limits or restrictions on mental health treatments, including substance use disorders, that are greater than those for other physical medical conditions.

But, advocates have argued that insurers have found loopholes to exploit, and regulation is primarily in the hands of the states.

A lack of enforcement could result in patients being denied coverage for mental health services and greater costs shifted to taxpayers and programs like Medicaid as mental health issues are exacerbated, said David Lloyd, a senior policy advisor with The Kennedy Forum, which tracks the federal law’s enforcement nationwide. The nonprofit was founded in 2013 by former Congressman Patrick J. Kennedy, who was the lead sponsor of the federal act.

Lloyd said “it’s better late than never” that Missouri is incorporating the federal law into state statute, which will allow greater enforcement.

“This is a really important step,” Lloyd said, “because it was almost a little bit of a no man’s land, in terms of who was in charge of oversight of commercial insurance plans that are fully insured.”

According to a 2019 U.S. Government Accountability Office report assessing the law’s enforcement, states varied in the frequency and type of reviews conducted, and at a federal level, it was unclear if oversight strategies were effective.

At the time, a survey by the GAO found that Missouri and Wyoming were the only two states that did not report that they conduct reviews for parity compliance before plans were approved for sale in their states. Centers for Medicare & Medicaid Services and the U.S. Department of Health & Human Services were also responsible for parity enforcement in four states, including Missouri and Wyoming, according to the report.

While Missouri just signed into law the enforcement of the federal act, other states, like California, have gone further and passed laws aimed at closing the law’s gaps.

Rep. Lewis, a former intensive care unit nurse and health care executive, said she has had people reach out who have been only allowed a limited number of visits to their therapist.

“Mental health is a chronic condition. So just like if you have a cardiac condition, you can go see your cardiologist as much as you need to. There’s no lifetime or annual limit,” Lewis said. “It’s not like … ‘You’ve gone to your cardiologist three times. Now you’re done. You’re cut off.’ But that’s what we see with mental health.”

Razer said he first became aware of the issue after a member of his staff heard a 2019 KCUR story detailing the state’s lack of action and the effects it was potentially having on Missourians in immediate need of services. Razer and Lewis said the pandemic has only exacerbated the need for accessible mental health treatment as reports of anxiety, depression and suicidal thoughts are on the rise.

“Hopefully, this is just another recognition moving forward that mental health is simply a health condition,” Razer said.

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