Policy Goal #1: Enforce and strengthen laws requiring insurance companies to provide equal benefits for mental health and substance use disorders as for physical health disorders
Too often private and public insurance companies deny coverage for necessary substance use treatment. State and federal laws require insurance plans to offer the same coverage for mental health and substance use conditions as they offer for physical health conditions. What does this mean for you and your loved ones?
Here are some examples:
- Your insurance plan cannot charge higher co-pays for substance use conditions than for physical health conditions.
- Your insurance plan cannot charge you more for prescription medications simply because they are used for treatment of substance use conditions.
- Your insurance plan cannot use different practices to approve care for substance use conditions than for other health services.
Your insurance plan cannot require your health provider to get prior authorization to begin behavioral health services more often than it does for other health services. These practices are referred to as Utilization Management processes.
- Mental Health Colorado supports enforcing laws that require public and private insurance companies to provide information about their coverage and why they approve services with their members. This includes providing information about how the coverage for substance use conditions compare with the coverage for physical health conditions. It also includes releasing information about why care is needed and/or the reason it is denied.
- To ensure that the criteria used to determine the need for substance use treatment are fair, we support the use of national utilization management criteria specifically designed to determine the need for substance use services across all insurance plans.
- We support enforcing and strengthening laws to ensure that insurance companies have enough adequately trained substance use providers to ensure that their members have a choice of provider and can access care as close to their home or work as possible.
Policy Goal #2: Ensure people get the mental health and substance use services they need when they need them
Currently, Colorado does not have the capacity to provide substance use services to everyone who needs care. This leads to long wait times or people having to go out-of-network or out-of-state for their care. We need to expand the system’s capacity to provide the right level of treatment, at the right time, to anyone in need of care.
- 28 of the 64 Colorado counties have no substance use or mental health treatment facility.[i]
- 67,000 Coloradoans did not get the substance use services they needed in 2017 and over half say that in addition to cost, the stigma of substance use was a reason they did not seek care.
- Young adults are the most likely to need but not receive substance use services.[ii]
- More Coloradans died from drug overdoses than automobile accidents in 2017.[iii]
Mental Health Colorado is committed to getting people the substance use services they need.
- Substance Use Care Coordination and Immediate Treatment: Many individuals who need treatment must wait weeks or months to access residential or outpatient services. When dealing with a substance use disorder, this could mean life or death. We must think larger and develop systems that can assess an individual’s needs and help them to get to the best treatment option when they need it. This will require both changes to how we help people find treatment and more options for treatment including medication assisted, intensive outpatient and residential treatment. We need better systems to connect people in need with services as soon as they are ready to start their recovery process, not weeks or months later.
- Mental Health and Substance Use Disorder Capacity Tracking System: For many individuals in crisis due to a mental health or substance use concern, finding the right place for care is incredibly difficult. As a result, people with mental health or substance use disorders often find themselves waiting long periods of time in a hospital emergency room while clinicians, law enforcement officers, or family members try to find a facility with an open bed that will accept them. This often means hours on the phone calling facilities throughout the state. If the person is aggressive, has past criminal justice involvement, is an adolescent, or has co-occurring mental health and substance use issues, their chance of finding services becomes extremely unlikely.
Mental Health Colorado proposes that the state implement a real-time tracking system of available psychiatric or substance use treatment beds and Medication Assisted Treatment facilities that would help families, law enforcement, counties, and emergency rooms locate an appropriate treatment option for an individual in crisis.
Policy Goal #3: Ensure that people with the most complicated needs have access to mental health and substance use services
People with the most severe and complicated substance use disorders often need specific kinds of care that are difficult to find and need extra help seeking care.
- According to the Office of National Drug Control Policy, approximately two-thirds of people experiencing chronic homelessness have a substance use disorder or other chronic health condition.[iv]
- An estimated 60% of youth in the juvenile justice system in the U.S. have a substance use disorder and an estimated 50% of adults in jails have a co-occurring substance use and mental health disorder.[v]
Individuals who are homeless or are involved with the criminal justice system and have a substance use disorder struggle to access adequate treatment options. Mental Health Colorado is committed to ensuring they are a priority population at the Colorado legislature.
- Mental Health Colorado supports further investment in diversion programs to make sure people are not incarcerated because they have a mental health or substance use disorder and that individuals who are in jail or prison have access to adequate treatment, including medications.
- We support improving the crisis response system so that it can adequately serve everyone who experiences a crisis in our state, including adolescents and individuals with co-occurring disorders (Intellectual and Developmental Disability/mental health issues or individuals with co-occurring mental health and substance use disorders).
Policy Goal #4: Increase the availability of mental health services in schools and early childhood settings
- We have implemented a plan to ensure that the best practices outlined in our School Mental Health Toolkit are used in every school district in the state by 2021.
- We are expanding the School Mental Health Toolkit to include information for schools on helping students and families reduce their risk of developing substance use conditions.
- Mental Health Colorado is currently working on best practices for early childhood mental health. This toolkit includes strategies for anyone interacting with young children to promote healthy social emotional development—from parents to child care providers.
- Medicaid can be a resource to help schools provide the mental health services their students need. Mental Health Colorado supports expanded eligibility requirements for the use of school Medicaid.
- Ensure that students with mental health related disabilities are not disproportionately removed from the classroom, suspended, or expelled.
Policy Goal #5: Ensure women get the mental health and substance use services they need during and after pregnancy
The time during and after a woman’s pregnancy is an important time in the life of both the mother and child. It is a time when new habits and life changes occur. Often women eat healthier, prioritize sleep, exercise regularly, quit smoking, and for many women who struggle with a substance use disorder, it creates an opportunity for treatment and recovery to begin. For women who are addicted and not able to stop using alcohol or drugs, shame and fear may create barriers to seeking help.
- Mental Health Colorado supports health practices in identifying substance use conditions in women who are pregnant and parenting and helping the woman get access to the services she needs.
- We support efforts to ensure that women do not lose their Medicaid coverage during the year after their pregnancy to ensure that women have the services and support they need to provide a healthy environment for their family.
- As a state, we must increase funding to expand the availability of residential and intensive outpatient programs for women with substance use disorders and their children.
[i] Colorado Health Institute. https://www.coloradohealthinstitute.org/research/options-residential-and-inpatient-treatment-substance-use-disorder
[ii] Colorado Health Institute.
[iii] Colorado Health Institute. https://www.coloradohealthinstitute.org/research/death-drugs
[iv] SAMHSA. https://www.samhsa.gov/homelessness-housing
[v] SAMHSA. https://www.samhsa.gov/criminal-juvenile-justice