Colorado Removes Mental Health Barriers, But Will it Break the Bank?

Publisher’s note: This article addresses mental health issues and suicide. If you or someone you know is thinking about suicide, please know that you are not alone, and free, confidential help is available 24/7. Call 800-273-8255 to talk to a counselor now. If you know of a teen that’s struggling with thoughts of suicide, you can also get them help by submitting an anonymous report through Safe2Tell Colorado.

The past few years haven’t been easy. COVID-19 has rocked the world, leading to shutdowns, lockdowns and several other “downs.” Unsurprisingly, many people’s mental health has taken a direct hit.

Even before COVID, Colorado had severe issues with mental health problems, especially in our teen population. These mental health issues often went undiagnosed and untreated due to cost barriers.

To combat this issue, lawmakers introduced and passed House Bill 21-1068, “Insurance Coverage Mental Health Wellness Exam,” a first-in-the-nation law that requires insurance companies to cover annual mental health exams, just like they do yearly physicals. For the most part, this bill is a significant step forward in treating mental health. But there are possible drawbacks. Here’s what you need to know.

Colorado’s Mental Health Crisis

If you’ve seen your physician for an annual screening, you’ve probably noticed that you must fill out a mental health screening questionnaire. Indeed, thanks to the Affordable Care Act (ACA) passage, colloquially known as Obamacare, insurers must cover mental health screenings.

However, a doctor performs these screenings during a physical exam, not a mental health professional. Consequently, mental health issues often aren’t recognized or addressed, which results in many not receiving treatment until they’re in crisis mode.

This is problematic for Coloradoans. According to the nonprofit advocacy group Mental Health America, Colorado is one of the worst states regarding mental health. In fact, data from the Substance Abuse and Mental Health Services Administration show that almost 20 percent of Colorado residents have some type of mental health illness. This is the third-highest rate in the country.

To help address this issue, and hopefully catch mental health issues before they reach the crisis point, lawmakers passed HB 1068.

Covered Mental Health Exams

Starting Jan. 1, 2022, when a large-group market insurance plan is issued or renewed, it must cover an annual 45–60-minute mental health wellness exam. And these exams must be performed by a qualified mental health professional. This exam is considered preventative care, which means insurance can’t require copayments, deductibles, or coinsurance. Thus, just like a routine physical, this results in zero out-of-pocket expense.

Starting in 2023, small group and individual plans must also meet these requirements. And the new law requires insurers to provide mental health coverage like physical health coverage — meaning that if someone is diagnosed with a mental health issue, insurance must cover the cost of the treatment equal to what they’d encompass for a physical diagnosis.

“The whole idea of an annual mental health wellness exam is that you would go every year just like you go to your doctor to your physical and spend 45-60 minutes, depending on your insurance plan, with a qualified mental health care provider that you can select from a large range of different types of providers and talk about the different things that are going on in your life,” stated bill sponsor, State Rep. Dafna Michael Janet. 

Of course, just like with an annual physical, people can choose whether to take advantage of this new offering.

Premium Increases?

Thanks to the passage of the ACA, each state is required to pick a “benchmark plan” that covers 10 Essential Health Benefits (EHB). In other words, individual states can choose the minimum health benefits each insurance company must offer in their policies, if the minimum standards meet federal guidelines.

However, states can’t implement requirements that fall outside the EHB without defraying the increased premium cost. To put it simply, if a state imposes a state-mandated benefit that’s outside of the EHB, the state must pay for the increased premium cost.

As part of HB 1068’s passage, the Colorado Division of Insurance is required to conduct a study about the bill’s possible impact on insurance premiums and submit this report to the Federal Department of Health and Human Services (HHS).

If HHS determines that the new state mandate is outside of the EHB mandated by the ACA, Colorado would be required to pay the cost of the premium increases. In that case, the law won’t go into effect.

If, however, HHS determines that the new mandate falls within the EHB required under the ACA, the law will go into effect as planned. If this happens, the insurance industry estimates that insurance premiums will increase by 1 percent and could further increase over time as more people use this benefit. This increase will be paid by consumers, meaning your health insurance might get more expensive. Obviously, that’s not the best news.

Nothing’s Perfect

Colorado has a mental health problem, and the hope behind HB 21-1068 is that preventative care will catch mental health issues before they reach the crisis point. That’s a goal everyone can get behind.

But there’s a cost associated with this new benefit. So far, estimates don’t have premiums increasing by a significant amount, but that could change when the law goes into effect. Consequently, this is something The Maverick Observer will continue to monitor.

The Maverick Observer, or “The Moe” as we affectionately call it, is an online free-thinking publication interested in the happenings in our town. We launched in February 2020 to hold our politicians and businesses accountable. We hope to educate, inform, entertain, and infuse you with a sense of community.