Bridging the gap in mental health coverage
By Charity Gourley
Under the Mental Health Parity and Addiction Equity Act (MHPAEA) and the Affordable Care Act (ACA), U.S. health plans are required to cover mental health services on par with other medical services. Even so, many participants still struggle to access the mental health care they need. Barriers such as high out-of-pocket costs, limited in-network providers or specialists, long waitlists, and inconsistent plan definitions of “medically necessary” services can prevent timely care.
The gap between coverage and access to care raises an important question: what strategies should plans consider to make sure participants get the care they need?
Integrated health plans
Primary care providers (PCPs) can serve as the first point of contact for patients, with many bringing up mental health concerns during routine appointments. A 2021 study[i] found that over one-third of care and one-quarter of medication prescribed for patients with serious mental illness was delivered by PCPs—many of whom lack the time, training, or resources to fully address mental health needs.
Plans that integrate mental health providers within the same network as primary care can improve care coordination, connect patients with the right providers and specialists and help PCPs continue to be engage with the patient’s whole health. Integrated systems can help ensure patients stay in-network, link mental and physical health care, and ultimately improve access, continuity, and clinical outcomes.
Virtual care options
During the COVID-19 pandemic, virtual care played a critical role in maintaining access to mental health services. While telehealth use for many medical services has declined since the pandemic peak, virtual visits for mental health have remained consistently high.[ii] Ensuring plans cover virtual mental health visits—and that in-network providers offer them—can make it easier for participants to seek care, access specialists, and schedule appointments at convenient times.
Employee assistance programs
Even with mental health parity-compliant coverage and virtual care, participants may face barriers such as stigma, cost concerns, or uncertainty about where to begin. Employee Assistance Programs (EAPs) and Member Assistant Programs (MAPs) provide a valuable bridge, offering short-term counseling, crisis support, and guidance for connecting to ongoing care. Benefits include:
- Immediate, confidential support: Rapid access to licensed mental health professionals, helping participants who may not yet be ready to engage their PCP or specialist.
- Navigation and coordination: Guidance to in-network providers, referral support, and explanation of plan benefits.
- Holistic approach: Many programs offer additional services such as financial or legal advice, child or eldercare resources, and other programs that help reduce stress.
Integrating EAPs or MAPs with the primary health plan allows multiemployer plans to address both clinical and logistical barriers, supporting participants before conditions escalate.
Managed behavioral health solutions
A variety of vendors provide access to mental health care through digital tools, clinical services, and network-based support. Some offer integrated solutions that combine virtual therapy, care navigation, evidence-based treatment matching, and EAP features. These programs often include case management, self-guided resources, and partnerships with credentialed behavioral health providers to improve access and outcomes. Their goal is to streamline mental health support for employees while reducing stigma and barriers to care.
Vendors that provide a suite of healthcare navigation services can:
- Customize support: Align programs and resources to your specific plan and network, using data-driven insights to identify participant needs.
- Assist with plan navigation: Help participants compare treatment options, locate providers, and coordinate approvals to reduce delays.
- Improve outcomes and satisfaction: Research in the Journal of Occupational and Environmental Medicine (2021)[iii] found that participants receiving proactive benefits guidance were more likely to use preventive and mental health services, experienced lower out-of-pocket costs, and reported higher satisfaction with their plan.
Personalized benefits guidance
Many participants struggle to understand what their mental health benefits cover, how much care may cost, and how to navigate networks. Dedicated wellness or benefits websites and consistent communications can complement coverage and clinical programs by:
- Educating participants: Clear communication about covered services, referral requirements, and in-network options reduces confusion and encourages care-seeking.
- Empowering participants: Dedicated benefits websites help participants self-serve and quickly access the information they need to make informed decisions.
For multiemployer plans, combining robust coverage with regular communications, a dedicated website and proactive guidance can ensure participants not only have mental health benefits but can effectively access and use them—supporting overall workforce wellbeing.
Does your plan bridge the gap between required coverage and received care?
Multiemployer groups can uncover meaningful opportunities to strengthen mental health coverage by analyzing existing data and member experiences. Rael & Letson can help with detailed plan analysis, vendor and program introductions and reviews, improved participant communications, custom websites, updated SPDs, and more. Contact us to get started.
[i] https://journals.sagepub.com/doi/10.1177/21501327211023871
[iii] https://journals.lww.com/joem/fulltext/2021/03000/workplace_mental_health__application_of_a.9.aspx