Legislative changes improve access to mental health care for pregnant and postpartum women

Pregnant and postpartum women with depression and anxiety are more likely to receive mental health treatment these days, a new study finds. And they pay less of their money when they do.

Changes in care and costs occurred primarily after the Affordable Care Act took effect in 2014, and to a lesser extent after the Mental Health Parity and Addiction Equity Act, or MHPAEA, work in 2010, the analysis shows.

Both laws are intended to reduce insurance-related barriers to mental health care.

However, only 10% of privately insured women who had an anxiety disorder or depression during pregnancy or during their postpartum year received psychotherapy in 2019 to 2020, according to the new analysis.

And with 25% of pregnant women and new mothers having at least one of these mental health diagnoses in 2019, up from 14% in 2007, that means more women are not I can get them evidence-based care that can help them too. babies.

Findings from the Maternal Behavioral Health Policy Evaluation Study (MAPLE) were published in JAMA Network Open by the University of Michigan team.

The gap between mental and physical health care closed slightly over time, and cost barriers decreased slightly. “

Kara Zivin, Ph.D., lead author

But these improvements occurred slowly even after insurance policies changed, perhaps due to a lack of mental health care providers, a lack of awareness of mental health conditions in related to pregnancy, and stigma against seeking mental health help.

“In this high-risk population, and in the context of what we know about the impact of mental health conditions on maternal mortality, many people are being missed,” said Zivin, a professor in the Department of Psychiatry and the Department of Obstetrics and Gynecology. Michigan Medicine, UM’s academic medical center.

“Even among the 50% of women with depression and anxiety who attended psychotherapy during this study period, the general population only had one visit,” she added.

Learning to influence health policy

Zivin and her colleagues looked at the impact of health policy changes for women with perinatal depression and anxiety disorders.

They used sophisticated statistical methods to analyze what happened after the MHPAEA and the ACA each went into effect. Both laws included provisions designed to require insurers to cover mental health care and physical health care equally and to treat mental health as a valuable benefit.

Overall, women’s access to mental health treatment began to rise after the MHPAEA and increased even more after the ACA.

This new study also shows a significant difference in costs from women who received psychotherapy at least once, depending on the time of year they received it.

Those whose elections occurred in the first months of the year paid an average of more than $50 out of pocket, compared to less than $25 for those who received care in the last month of 2018 and 2019.

The analysis showed that this seasonal difference increased after the Affordable Care Act went into effect. The nation-wide increase in employer-sponsored health plans and the ACA marketplace may contribute to fluctuations in out-of-pocket costs throughout the calendar year. Such plans require the insured to pay the full cost of care at the beginning of each coverage year until they reach the amount set as their plan’s deductible.

More on education

Zivin and her colleagues looked at data from more than 716,000 women between the ages of 15 and 44 who gave birth between 2007 and the end of 2019 in the United States, for a total of more than 837,000 babies. . All had been enrolled in the same health insurance plan for at least one year prior to delivery.

The group focused on those with a mental health diagnosis within two years surrounding their delivery. Within this group, they looked at those who used insurance to pay for at least one psychotherapy visit with a mental health provider.

The findings build on the team’s recently published work that suggests alternatives to prenatal mental health screening and care, including increased antidepressant treatment.

The new study does not include women covered by Medicaid, who tend to have low incomes and account for 42% of births in the United States.

The study also did not include women who did not use insurance to pay for mental health treatment, for example because they saw a mental health provider who did not accept insurance at all, or who did not join the insurance plan’s network.

That kind of “private income” status doesn’t appear in the data source the team used, Optum’s deidentified Clininformatics Data Mart Database.

More research is needed

Zivin notes that the data in this study comes largely before the COVID-19 pandemic, when insurers were starting or expanding coverage for mental health care.

Further research on data from 2020 onwards should examine whether access to the telephone has increased the percentage of pregnant and postpartum women receiving mental health treatment, he says – for example, if they live in areas with a shortage of growth of mental health providers.

Zivin also suggests that health insurance related laws will not directly address the ongoing shortage of mental health providers.

That shortfall stems from the very issue that mental health laws aim to address: decades of disparities in mental health care and physical health care under private insurance. and public programs such as Medicaid and Medicare.

In addition to Zivin, study authors include senior author Vanessa Dalton, MD, MPH, and co-authors Xiaosong Zhang, MS, Anca Tilea, MA, Stephanie V. Hall, Ph.D., Lindsay Admon, MD , M.Sc. and Ashlee Vance, Ph.D.

Zivin is a member of the Center for Medicine Management Research at the VA Ann Arbor Healthcare System; he, Admon and Dalton are members of the UM Institute for Healthcare Policy and Innovation. Vance, a former National Clinician Scholar at IHPI, is now at Henry Ford Health.

The National Institute of Mental Health (R01MH120124) and the National Institute on Minor Health Disparities and Health (R01MD014958) funded this study.