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Monday, July 25, 2011

Coalition for Whole Health Recommendations on Coverage of Mental Health and Substance Use Disorder Services in the Essential Health Benefit Package

In 2010, Congress enacted the Affordable Care Act (ACA), which will substantially expand health insurance coverage for Americans, largely through state health insurance Exchanges for individuals and small businesses, and through an expansion of Medicaid for low-income individuals and families. ACA requires the plans in the Exchanges, as well as Medicaid expansion plans, to cover a set of “essential health benefits” that include “mental health and substance use disorder [MH/SUD] services, including behavioral health treatment.” By including MH/SUD as essential services, Congress recognized that substance use disorders and mental illnesses are preventable, treatable health conditions, as accepted by the American Medical Association, all other public health and medical standards, and decades of scientific research.

A well designed Essential Health Benefits package that includes sufficient coverage for mental health and substance use disorders for children, youth and adults is central to efforts to ensure that health reform meets its potential to allow individuals and families to recover from these diseases, improve health, and bend the cost curve. The Coalition for Whole Health, a coalition of national organizations advocating for improved coverage for and access to mental health and substance use disorder prevention, treatment, rehabilitation, and recoveryservices, recommends full inclusion of mental health and substance use disorder services within the Essential Health Benefits framework. This includes incorporating MH/SUD services in each of the Essential Health Benefits categories, as appropriate, in addition to the mental health and substance use disorder services category per se.
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