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Articles   |    
Impact of State Mental Health Parity Laws on Access to Autism Services
Lucy A. Bilaver, Ph.D.; Neil Jordan, Ph.D.
Psychiatric Services 2013; doi: 10.1176/appi.ps.201200411
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Dr. Bilaver is affiliated with the School of Nursing and Health Studies, Northern Illinois University, Wirtz Hall 235, DeKalb, IL 60155 (e-mail: lbilaver@niu.edu). Dr. Jordan is with the Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago.

Copyright © 2013 by the American Psychiatric Association

Abstract

Objectives  This study examined the effect of state mental health parity laws on family financial burden, satisfaction with health insurance, and receipt of needed mental health services for privately insured children ages three to 17 with autism spectrum disorder (ASD).

Methods  Data came from the 2005–2006 wave of the National Survey of Children With Special Health Care Needs. An econometric approach with instrumental variables was used to control for the nonrandom selection of states according to their mental health parity laws. The study analyzed data for 949 youths with ASD and private health insurance. Six outcome variables were examined, including several measures of family financial burden, satisfaction with health insurance, and receipt of needed mental health services.

Results  Families of children needing mental health services and living in a state with a strict parity law had a 61% higher probability of reporting out-of-pocket spending >$1,000 compared with those not living in a strict parity state. Compared with families of children living in a strict parity state that did not specify ASD, those living in a strict parity state that specified ASD had a 92% higher probability of reporting unreasonable out-of-pocket spending. All other results were statistically insignificant.

Conclusions  In contrast with previous research, this study did not find strong evidence that state mental health parity laws positively affected service access for children with ASD. Future research on the effect of autism insurance reform will provide a more precise test of the impact of insurance mandates on improving access to treatment services for children with ASD.

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Table 1Parity laws in the United States, by level of restriction and coverage of autism spectrum disorder (ASD)
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a State laws were unclear with respect to treatment of ASD. None were considered to explicitly or implicitly cover ASD.

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b State with a parity law in effect during the study period but which failed to meet the study criteria for strict parity. Although lacking strict parity, 6 of these states (Florida, Illinois, Kansas, Louisiana, Massachusetts, and Mississippi) had laws that explicitly or implicitly covered ASD.

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c Excluded from the analysis because the parity law for this state was enacted during the time of survey data collection.

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Table 2Descriptive statistics by type of state parity law, NS-CSHCN 2005–2006a
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a Values are weighted percentages and means±SE, with weights and design elements of the National Survey of Children With Special Health Care Needs (NS-CSHCN) applied to the study subpopulation (N=949).

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b Values reflect the comparison across the three parity law types; means were compared by t tests and proportions by chi square tests.

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c The index ranges from 0 to 3, with higher scores indicating a more Democratic versus Republican state government.

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d The index ranges from –1 to 1, with positive scores indicating an electorate that self-identify more as liberals than conservatives.

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e Possible scores range from .04 to .66, with higher scores indicating a higher percentage of professionalism in the state’s legislature compared with the U.S. Congress in 1986.

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Table 3Effect of strict state parity laws on outcomes of children with an autism spectrum disordera
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a All estimates are weighted with weights and design elements of the National Survey of Children With Special Health Care Needs applied to the study subpopulation. Model 1 regressed each of the outcomes on living in a strict parity law state, child demographic characteristics (age, gender, and race-ethnicity), being interviewed in a language other than English, one adult in household, mother with high school education or less, poverty level, parent-reported severity, parent-reported time affected, parent-reported stability of need, and child needing mental health services in the past 12 months. Model 2 added to model 1 an interaction between needing mental health services and living in a strict parity law state. Unweighted N=949 for all four models.

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b First-stage model 1, F=5.10, df=3 and 47, p=.004; first-stage model 2, with parity law in effect, F=10.02, df=6 and 47, p<.001, parity law in effect × needed mental health care, F=4.47, df=6 and 47, p=.001

Table Footer Note

*p<.05, **p<.01

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Table 4Effect of condition-specific state parity laws on outcomes of children with an autism spectrum disordera
Table Footer Note

a All estimates are weighted with weights and design elements of the National Survey of Children With Special Health Care Needs applied to the study subpopulation. Each of the outcomes was regressed on parity law type, child demographic characteristics (age, gender, and race-ethnicity), being interviewed in a language other than English, one adult in household, mother with high school education or less, poverty level, parent-reported severity, parent-reported time affected, parent-reported stability of need, and child needing mental health services in the past 12 months.

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b First stage, parity law in effect with condition specificity, F=.76, df=3 and 47, p=.523; first stage, no parity law in effect, F=5.10, df=3 and 47, p=.004

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*p<.05, **p<.01

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References

 Prevalence of autism spectrum disorders: autism and developmental disabilities monitoring network, 14 sites, United States, 2008.  Morbidity and Mortality Weekly Report 61:1–19, 2012
 
Leibowitz  A;  Manning  WG,  Jr;  Keeler  EB  et al:  Effect of cost-sharing on the use of medical services by children: interim results from a randomized controlled trial.  Pediatrics 75:942–951, 1985
[PubMed]
 
Manning  WG;  Wells  KB;  Buchanan  JL  et al:  Effects of Mental Health Insurance: Evidence From the Health Insurance Experiment .  Santa Monica, Calif,  RAND, 1989
 
Frank  RG;  McGuire  TG;  Bae  JP  et al:  Solutions for adverse selection in behavioral health care.  Health Care Financing Review 18:109–122, 1997
[PubMed]
 
Frank  RG;  Glazer  J;  McGuire  TG:  Measuring adverse selection in managed health care.  Journal of Health Economics 19:829–854, 2000
[CrossRef] | [PubMed]
 
Peck  MC;  Scheffler  RM:  An analysis of the definitions of mental illness used in state parity laws.  Psychiatric Services 53:1089–1095, 2002
[CrossRef] | [PubMed]
 
Sturm  R;  Pacula  RL:  State mental health parity laws: cause or consequence of differences in use? Health Affairs 18(5):182–192, 1999
[CrossRef] | [PubMed]
 
Pacula  RL;  Sturm  R:  Mental health parity legislation: much ado about nothing? Health Services Research 35:263–275, 2000
[PubMed]
 
Effects of the Vermont Mental Health and Substance Abuse Parity Law. Rockville, Md, Substance Abuse and Mental Health Services Administration, 2003. Available at store.samhsa.gov/product/Effects-of-the-Vermont-Mental-Health-and-Substance-Abuse-Parity-Law/SMA03-3822. Accessed Nov 18, 2013
 
Barry  CL;  Busch  SH:  Do state parity laws reduce the financial burden on families of children with mental health care needs? Health Services Research 42:1061–1084, 2007
[CrossRef] | [PubMed]
 
Barry  CL;  Busch  SH:  Caring for children with mental disorders: do state parity laws increase access to treatment? Journal of Mental Health Policy and Economics 11:57–66, 2008
[PubMed]
 
Blumberg  SJ;  Welch  EM;  Chowdhury  SR  et al:  Design and operation of the National Survey of Children With Special Health Care Needs, 2005–2006.  Vital and Health Statistics Series 1: Program and Collection Procedures 1(45):1–188, 2008
 
Bethell  CD;  Read  D;  Neff  J  et al:  Comparison of the Children With Special Health Care Needs screener to the Questionnaire for Identifying Children With Chronic Conditions—Revised.  Ambulatory Pediatrics 2:49–57, 2002
[CrossRef] | [PubMed]
 
Lang  M:  The impact of mental health insurance laws on state suicide rates.  Health Economics 22:73–88, 2013
[CrossRef] | [PubMed]
 
Angrist JD, Pischke J-S: Instrumental variables in action: sometimes you get what you need; in Mostly Harmless Econometrics: An Empiricist’s Companion. Princeton, NJ, Princeton University Press, 2008
 
Van Sickle-Ward  R:  The politics of precision: specificity in state mental health policy.  State and Local Government Review 42:3–21, 2010
[CrossRef]
 
Dubin  MJ:  Party Affiliations in the State Legislatures: A Year by Year Summary, 1796–2006 .  Jefferson, NC,  McFarland, 2007
 
Wright  GC;  Erikson  RS;  McIver  JP:  Measuring state partnership and ideology with survey data.  Journal of Politics 47:469–489, 1985
[CrossRef]
 
Squire  P:  Measuring state legislative professionalism: the Squire index revisited.  State Politics and Policy Quarterly 7:211–227, 2007
[CrossRef]
 
Stata: Statistical Software, Release 12. College Station, Tex, Stata Corp. Available at www.stata.com
 
Parish  S;  Thomas  K;  Rose  R  et al:  State insurance parity legislation for autism services and family financial burden.  Intellectual and Developmental Disabilities 50:190–198, 2012
[CrossRef] | [PubMed]
 
Stock  JH;  Wright  JH;  Yogo  M:  A survey of weak instruments and weak identification in generalized method of moments.  Journal of Business and Economic Statistics 20:518–529, 2002
[CrossRef]
 
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