Commentary: Legislative opportunities to address growing addiction and mental crises

By Ellen Weber and Dr. Laura Willing

Weber is senior vice president for health initiatives at the Legal Action Center, and Willing is the medical director for mental health policy and advocacy the Community Mental Health CORE at Children’s National Hospital.

Right now, during Maryland’s 2024 legislative session, the state has multiple opportunities to improve insurance coverage and access to substance use and mental health care for individuals and families across the state. With more than 2,500Marylanders lost to overdose in 2023 alone, 922,000 individuals in the state age 12 and older documented as having a substance use disorder, and another 1,089,000 struggling with mental illness, the urgency is clear. We must act to save lives now!

Under state and federal parity laws, Marylanders have a right to non-discriminatory health insurance coverage for substance use and mental health care and services. Essentially, parity laws require health plans to cover these services equally, or at parity with, benefits offered for other medical care and services.

Further, insurers are required to demonstrate that they offer such coverage by submitting reports that prove their plans meet these non-discrimination standards. A scathing report released by the Maryland Insurance Administration at the end of 2023 stated that no carrier in the state has complied. And some of Maryland’s largest carriers have already been fined nearly $1 million for these violations.

Without sufficient reporting, the state has no way to ensure insurers are complying with the law. Meanwhile, insurers get away with unfairly denying authorization for substance use disorder and mental health care, inadequately reimbursing in-network providers and/or imposing burdensome administrative requirements on providers that deter them from joining networks in the first place.

While all this insurance talk may sound confusing, it’s as simple as this: Marylanders’ lives are put at risk when they are denied coverage of substance abuse disorder and mental health care and/or cannot find a treatment provider who takes their insurance. And young Marylanders have an even greater need for care — medical leaders declared a National Emergency in Child and Adolescent Mental Health in October 2021 and urged for stronger enforcement of parity laws to improve youth mental health. Maryland legislators must heed this call to address these perilous barriers to care.

The state’s Parity Act Compliance Reporting law must be strengthened to hold health insurers accountable and ensure Marylanders can access and afford the treatment they need. Working closely with the the Maryland Insurance Administration, advocates have helped develop legislation (House Bill 1074/Senate Bill 684) that will give the MIA the authority and strong oversight it needs to stop insurers from violating state and federal parity laws and put an end to the deadly treatment gap that harms so many people and families.

Too often, individuals fall through the cracks because they can’t find a doctor who takes their insurance to help treat their opioid use disorder without waiting for months or having to travel miles away from their home for an appointment. People may be forced to pay exorbitant out of pocket fees for care, causing them economic distress and instability when they’re already dealing with the stress of their health issue. Urgently needed substance abuse disorder or mental health care may be dangerously delayed for youth as families try to navigate confusing and complicated prior authorization barriers, step therapy and limited networks. The list goes on.

To fill these cracks and improve access to and affordability of substance use and mental health care for all Marylanders, we are monitoring HB 1074/SB 684 and recommend that:

• Reporting and compliance verification be done annually on a sufficient number of plan features so that consumers have proof of fair coverage.
• The standards in the state’s reporting law align with the federal law, meaning the information and data collected from the state health plans and the tool used to verify their compliance should include what’s detailed now and in the future in the federal standards.
• Insufficient reporting be treated as a parity violation, and a penalty provision is adopted so insurers that fail to submit a complete compliance report would have to pay a fine for every day their report is incomplete. Penalties could be placed in a Parity Act Compliance Fund, as New York requires, which would help support further enforcement actions, community education, and a consumer assistance program.

Insurance is complicated, but accessing affordable, timely, life-saving substance use and mental health treatment shouldn’t be. Maryland has the opportunity right now to advance important legislative changes that will make it easier for individuals and families statewide to access the care they need and deserve.

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