Washington is one of 30 states plus the District of Columbia to receive a portion of an $8.6 million grant awarded through the State Flexibility to Stabilize the Market program created under the federal Affordable Care Act.
Washington received $284,135 of the total grant funding. Our state chose to focus the use of the funding to bolster access to mental health and addiction treatment services.
Insurance Commissioner Mike Kreidler applied for the grant to conduct a thorough analysis of whether health insurers in Washington offer comprehensive and affordable health coverage for mental health and substance use disorder treatments. Under the grant, his office will study health plan benefit design, insurers’ policies and procedures for coverage of these services, and claims data.
“This grant will help us do the research needed to uncover any barriers to behavioral health services that may exist for Washington consumers,” said Kreidler. “We are committed to doing our part to fight the opioid crisis facing many communities today. If changes are needed to improve insurance coverage for people, this grant will help inform our work and the efforts we’re taking as a state.”
“To save lives and make an impact on the opioid crisis, state and local government agencies will need to work together,” Gov. Jay Inslee said. “I am grateful to Commissioner Kreidler for his efforts to ensure that individuals and families have access to mental health and addiction resources. If we want to end this crisis, we need to break down all treatment barriers people may face, and insurance coverage is critical.”
Kreidler’s office intends to form an advisory committee of consumers, medical and behavioral health providers and insurers to begin work this fall. The project will include two phases:
- Phase one: Create and issue two successive market scans that will be used to identify any barriers, including access barriers, to mental health and substance use disorder treatment services. The project will also contract with a consultant to review insurers’ medical necessity and prior authorization criteria and procedures related to selected behavioral health services.
- Phase two: Conduct more detailed claims analysis, informed by the results of the market scans, using All Payer Claims Database data as well as supplemental substance use disorder and denied claims data.
Analysis of the data will reveal if there are any coverage gaps or disparities in how behavioral health is covered compared to other health services and identify possible solutions.
Any issues uncovered during the data collection and Kreidler’s recommendations will be part of a detailed report produced at the end of the two-year grant.