Exploring Early Effects of Colorado’s Annual Mental Health Wellness Exam Policy

• In Event: Mental Health Services and Policy

Abstract

Introduction. The cost of mental health care remains a significant barrier among privately insured adults in the US. In 2021, Colorado passed a law mandating coverage of a 60-minute annual mental health wellness exam, with a mental health specialist, with no cost-sharing. Unequivocally, lowering the effective price of care should lead to an increase in demand for this type of care. The welfare implications are less clear. Proponents of the policy argue that mental health conditions are undertreated in the US, and this policy will be welfare enhancing. On the other hand, detractors argue that the policy has the potential to create moral hazard which could lead to longer delays for care among those who truly need it. Large group plans were required to provide coverage beginning in 2022, however the policy excluded self-insured employer plans, exempt from state-level insurance regulation under the federal Employee Retirement Income Security Act (ERISA) of 1974. We sought to examine the effect of Colorado’s annual mental health wellness exam policy on commercially insured adults.

Methods. We used 2020-2023 data from the Colorado All-Payer Claims Database. We included commercially insured adults with at least two years of continuous coverage, excluding individuals with more than one employer or with an employer that switched market segments over the study period. Using a difference-in-difference design, we compared adults in fully insured large employer group to those in ERISA-based employer group plans. The main outcomes included if the member received a psychotherapy intake visit, if the member received any behavioral health visit, and outcomes measuring different treatment trajectories (e.g., behavioral health diagnoses, inpatient and outpatient mental health care utilization, psychotropic fills). All models adjusted for insurance plan type and included member and quarter-year fixed effects.

Results. The analytic sample was comprised of 318,957 unique individuals. Our event study models found no difference in pre-trends across our outcome variables. Colorado’s annual mental health wellness exam policy led to a 0.2 percentage point increase (95% CI: 0.2, 0.3) in the probability of having a psychotherapy intake visit in a quarter-year, corresponding to a 24.5% (95% CI: 18.6, 30.3) increase relative to the pre-policy baseline of 0.76%. The policy led to a 1.5 percentage point increase (95% CI: 1.4,1.7), or a 23.6% increase (95% CI: 20.9, 26.3) relative to the baseline of 6.1%, in the probability of having any behavioral health visit in a quarter-year. We found a 1.9 percentage point increase (95% CI: 1.7, 2.1), or a 23.9% (95% CI: 21.6,26.2) increase relative to the baseline of 7.3%, in the probability of having a mental health diagnosis in a quarter-year.

Conclusion. We find that the annual mental health wellness exam policy led to a higher share of individuals enrolled in fully insured large group employer plans having at least one psychotherapy intake visit, accessing any behavioral health care, and having a mental health diagnosis in the past three months. Since 2021, three states have passed similar laws. These findings provide initial insights on policy effects and warrant further investigation.

Author

• Hridika Shah, Johns Hopkins University
  Presenting Author