Statewide View: Tough days for those in pain -- Minnesota must improve its mental health parity

Access to mental health services is elusive for many, and deaths from drug and alcohol misuse and suicide have skyrocketed. In reality, few individuals who have a mental health need get the care they need. Consider that just one in 10 individuals...

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Denfeld’s 1947 boys basketball team is the only Denfeld basketball team to win a state title. The team’s head coach was Lloyd Holm. Team members were Rudy Monson, Larry Tessier, Paul Nace, Kenneth Sunnarborg, Eugene Norlander, Howard Tucker, Tony Skull, Jerry Walczak, Bruce Budge, Keith Stolen and student manager Bob Scott.

Access to mental health services is elusive for many, and deaths from drug and alcohol misuse and suicide have skyrocketed.

Benjamin F Miller

In reality, few individuals who have a mental health need get the care they need. Consider that just one in 10 individuals who needs substance use treatment accessed that care at a specialty facility in 2016. And, currently, the state's health care system - like the rest of the country - is fragmented, with mental health being seen for decades as a separate and distinct element from physical care.

In 2018, no one argues about the need to cover and improve access to mental health services. Yet, mental health parity laws - those that require insurers to cover mental health issues, such as depression or substance use disorders, at the same level as illnesses of the body, such as chronic or infectious diseases - remain incredibly weak for almost every state.

In a recent analysis, 32 states received a failing grade when it comes to enforcing parity. Minnesota was chief among them, scoring just 51 out of 100. There's certainly room for improvement in Minnesota's laws.


Strong state statutes enforcing parity laws are among the critical foundations for helping end discrimination in the coverage of mental health and substance use disorder services - and changing the culture of what people can expect from health care.

Without robust parity laws and their enforcement, it's basically a lottery as to what type of care a person might get. There is little accountability around enforcement and seemingly no transparency as to what plans offer for medical and mental health benefits; patients, providers, and policymakers often do not know whether a health plan complies with parity laws and what they should expect from their health benefits.

Minnesota policymakers can take a number of steps, right now, to improve parity and help ensure people have proper coverage for mental health and substance use disorders.

• Mental health conditions must be recognized as broadly as physical health conditions. This would ensure the full gamut of mental health conditions are covered as comprehensively as physical diagnoses.

• Co-pays and out-of-pocket costs must be the same for mental health services as for physical health services. As such, states should require that benefit-management processes and treatment limitations are no more restrictive than similar limitations for physical health benefits. Mental health services must also have the same coverage limits as services for the treatment of physical ailments.

• Policymakers should strengthen enforcement and compliance activities by empowering regulatory agencies to enforce parity laws, including the Federal Parity Law. In addition, states should require monitoring agencies to regularly report on steps taken to enforce compliance and mandate that all health benefit plans submit regular analyses demonstrating compliance with the law.

• Policymakers should increase parity enforcement efforts and update oversight mechanisms through intensive compliance verifications and reviews of consumer complaints. They also should require health plans to submit detailed compliance analyses, and they should compel plans to come into compliance.

• Policymakers should designate a lead for parity with the commensurate resources to regulate and enforce parity laws and hire and fund consumer-advocate offices and other experts who can help patients understand, file, and process parity claims and appeals.


Parity remains elusive for many. Everyday people are being denied care and have few resources to advocate on their own behalf. It's time to right a wrong, to see mental health for what it is: an essential and core component to health and well-being.

We cannot afford to sit idly by as decades pass. People need comprehensive mental health coverage and care. Now.


Allison O'Toole of the Twin Cities is director of state affairs for United States of Care ( and previously was CEO of MNsure, Minnesota's health insurance public exchange. Benjamin F. Miller of Denver is chief strategy officer at Well Being Trust (

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