Illinois Health Insurance Now Requires Coverage For Mental Health and Substance Abuse
If you or your loved one has been struggling to pay out-of-pocket expenses for substance abuse and mental health treatment in Illinois, there is great news.
A bill signed into law last year by Gov. J.B. Pritzker goes into effect on January 1, 2023. Medical insurers will now be required to provide coverage for medically necessary treatments and services for substance abuse and nervous, emotional, and mental conditions and disorders.
During the announcement, Gov. Pritzker reiterated that his government is making bold changes to mental health care provisions throughout the state, pointing out that the new law will help residents get essential mental health care and services regardless of location or financial status. In a statement following the announcement, the governor urged all stakeholders to recognize that mental health is a part of mainstream health care and should be treated as such.
Via Gov Pritzker’s signing into law of the so-called mental, emotional, nervous, or substance use disorder or condition parity, Illinois became the 3rd state in the country to pass such legislation. Only Oregon andCalifornia have already enacted such laws. According to numerous advocates, including the leadership at The Kennedy Forum, Illinois is at a juncture where the need for substance abuse treatment andmental health care is more important than ever, especially when considering two crises that many communities face in the Land of Lincoln.
Despite an apparent spike in demand for mental health and substance abuse treatment, patients aren’t often able to access services because insurers won’t pay for them. People seeking these essential services are forced to pay out of pocket for treatment and care. Most decide to skip care or treatment altogether. It doesn’t help when current health plans are vague when it comes to mental health coverage. The new law, which will go into force at the beginning of 2023, is meant to make coverage decisions easier and more transparent, providing clear standards and definitions of instances where treatments and services are deemed medically necessary.
The new legislation always calls on grandfathered plan providers, commercial insurers, and Medicaid managed care organizations to use publicly available guidelines to determine what’s deemed medically necessary. Interestingly, these guidelines get drafted, reviewed, and published by nonprofit clinical associations and institutions. When a practitioner says that care or treatment is needed, commercial insurers and Medicaid providers can’t refuse. At the moment, insurers often wait until the patient is in crisis and critically sick to provide coverage.
At the same time, insurers are not allowed to limit benefits to acute and short-term treatment or refuse to provide coverage for specific types of mental health care. Basically, an insurer is prohibited from saying it’ll only cover only five or eight treatment sessions when a practitioner says you need ten. If your insurance company refuses to cover your care or treatment, in spite of your doctor’s advice, you can appeal this decision and most likely win.
The new law will help establish transparent, uniform, and easy-to-understand guidelines, making it even easier for practitioners to submit the necessary coverage documentation to medical insurance companies. Not only does the new legislation eliminate barriers to care access, but it’ll also help remove the stigma around seeking treatment and care for substance abuse disorders and mental health in Illinois.