Wisconsin's new BadgerCare Plus Core health insurance plan — designed to provide health coverage to 50,000 low-income adults — violates state and federal addiction and mental-health parity laws, according to critics.
The Madison Capital Times reported Dec. 6 that the BadgerCare plan does not cover treatment from counselors, psychologists, therapists, social workers, addiction experts or other providers of mental health and addiction services. The plan also denies reimbursement for inpatient hospital care for addiction and mental health.
Parity laws require that no limits on coverage be placed on addiction and mental-health care that do not apply to other health services.
State officials said that cost was an issue and that they are awaiting guidance from the federal Centers for Medicare and Medicaid Services, due in January. “This is pure hypocrisy,” said Diane Greenley, an attorney with Disability Rights Wisconsin in Madison and a staffer at the Wisconsin Council on Mental Health.
BadgerCare officials claimed that the plan isn't in violation of the federal law because it permits unlimited visits with psychiatrists. “The parity law does not require plans that provide [mental health and substance abuse disorder] benefits to provide access to all services for those conditions,” an agency spokesperson said.
Wisconsin addiction and mental health advocates said that limiting treatment to psychiatrists is an illegal treatment limitation not applied to other medical conditions, and noted that many psychiatrists don't take Medicaid patients because they feel the reimbursement rate is too low.
“The law says that if you offer mental health benefits there can be no artificial constraints,” said David Riemer, policy director of the Milwaukee-based Community Advocates Public Policy Institute. “On the health side, if you go to a doctor you can get a referral to a rehab specialist. So on the addiction side, if you go to a psychiatrist, you should be able to get a referral to an addictions rehab specialist.”
“Creating the Core plan was a creative and courageous act,” Riemer added. “It's already saving lives, improving health, and sparing the poor from even greater financial pressure than they already face. But we are a nation of laws, and the federal Wellstone-Domenici [parity] law needs to be followed. And we need parity for the Core plan, as for all health insurance plans, because it promotes good health care.”