By Emmanuelle St. Jean​, NACo Program Manager.

The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 requires health plans to provide coverage for mental and substance use disorder services on par with medical/surgical benefits for  individuals with employer-sponsored health plans with 50 or more employees. In November 2013, the federal government published its final regulations for the law.  Why is this important to counties and what does it mean for counties?

Almost 1 in 5 American adults (18.6 percent; 43.7 million) had a mental, behavioral, or emotional disorder in 2012, according to the National Survey on Drug Use and Health.[1] About 34.1 million (14.5 percent) American adults received mental health treatment or counseling in the past 12 months.  The survey also found that of the 23.1 million people 12 years of age and older who needed treatment for substance use, 20.6 million did not receive treatment at a specialty facility (i.e., hospital inpatient, drug or alcohol rehabilitation, or mental health centers). While there are no current estimates of the costs to employers, previous research indicated mental illnesses and substance use disorders cost employers 217 million days of work loss and work impairment and $17 billion annually.

The parity law ensures individuals with a mental illness or substance use disorder will have coverage for treatment and services that is comparable for the services and treatment they receive for other health conditions. The Affordable Care Act enhances the parity law by requiring coverage of treatment for mental health and substance use disorders. These two laws interact with one another and have significant implications for counties as employers. Below are some of these implications.

  1. County health plan mental health and substance use disorder treatment coverage should comply with the MHPAEA regulation.
  2. State parity laws may be stronger than MHPAEA. If this is the case, health plans should comply with state laws and regulations.
  3. Health plans cannot have different limits on co-pays, deductible, and co-insurance for mental health and substance use disorder treatment than on physical health treatment – this is particularly important for employers that may have a “carve out,” i.e., the behavioral health services are provided by a different insurer than the one that covers physical health.
  4. Current health plans should not have any annual or lifetime dollar limits on behavioral health services.
  5. Employees should be provided with information about their benefits and be allowed to appeal if their insurer denies a claim
  6. The federal parity law does not apply to retiree-only health plans.

As counties seek to ensure the health and well-being of their employees, optimizing behavioral health coverage is critical as the economic and social costs are high. In conjunction with the Affordable Care Act, the federal mental health and addiction parity law offers employees living with behavioral health conditions access to care and effective treatment to lead healthy lives.

[1] Substance Abuse and Mental Health Services Administration, Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-46, HHS Publication No. (SMA) 13-4795. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013.  Available at:

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Reprinted with permission from the National Association of Counties –