Benefit limits in managed behavioral health care: do they matter?

Area of Science:

• Health Services Research
• Mental Health Policy
• Behavioral Health Economics

Background:

• Over half of Americans with mental health insurance are in plans with "carve-out" vendors for behavioral health services.
• Utilization management is common, but the impact of benefit limitations remains unclear.
• Managed behavioral health care is a significant component of mental health service delivery.

Purpose of the Study:

• To determine the prevalence of benefit limits encountered by enrollees in managed behavioral health care carve-out plans.
• To estimate the impact and cost savings associated with imposing benefit limits.
• To assess the cost of eliminating benefit limits and identify vulnerable populations.

Main Methods:

• Analysis of enrollee data within managed behavioral health care carve-out plans.
• Estimation of the impact of benefit limitations on service utilization.
• Calculation of potential savings from imposing benefit limits and costs to remove them.

Main Results:

• Benefit limits affect a small percentage of plan enrollees.
• The cost to eliminate benefit limits is estimated to be minimal.
• Children are particularly vulnerable to inpatient benefit limitations.

Conclusions:

• While benefit limits impact few, their existence warrants attention, especially for pediatric inpatient care.
• The findings have significant implications for ongoing debates on managed care in mental health.
• This research informs discussions regarding mental health parity legislation and its effectiveness.