CMS Did Not Ensure That Selected States Complied With Medicaid Managed Care Mental Health and Substance Use Disorder Parity Requirements
Learn how the AI-generated research projects were createdOverall Conclusion
CMS did not ensure that selected States complied with Medicaid managed care MH/SUD parity requirements; noncompliance was widespread across eight States, including missing parity provisions in contracts, lack of parity analyses and public posting, and restrictive practices by MCOs on MH/SUD benefits. CMS concurred with the recommendations and outlined actions to strengthen oversight and guidance.
Source Document
Audit Scope
Audit assessed CMS oversight of MH/SUD parity compliance in Medicaid managed care across eight states (Arizona, New Jersey, New York, Texas, Illinois, Kansas, Mississippi, and South Carolina) with Medicaid managed care contracts in effect on or after October 2, 2017. The objective was to determine whether CMS ensured that selected States complied with Medicaid managed care MH/SUD parity requirements, including whether state contracts with Medicaid Managed Care Organizations (MCOs) contained MH/SUD parity provisions by the compliance date (October 2, 2017), whether parity analyses were conducted and posted to the public by the compliance date, and whether MH/SUD benefits were delivered in parity. The parity analyses cover four benefit classifications (inpatient, outpatient, prescription drugs, and emergency care) and test five elements: (1) aggregate lifetime and annual dollar limits; (2) financial requirements (coinsurance, deductibles, copayments, and out-of-pocket maximums); (3) quantitative treatment limitations (QTLs); (4) nonquantitative treatment limitations (NQTLs); and (5) availability of information related to medical necessity and denial reasons. CMS oversight included review of state and/or MCO parity analyses, contract provisions, and the posting of compliance information on state Medicaid websites. Fieldwork occurred August 2022 through October 2023, with reference to the compliance date and historical parity activities dating back to 2017; extensions were granted in certain cases, and data from 2017–2023 were analyzed to assess ongoing compliance.
Key Findings Summary
CMS did not ensure that selected States complied with Medicaid managed care MH/SUD parity requirements. For all eight States reviewed, State contracts with Medicaid MCOs did not contain required parity provisions by the compliance date (October 2, 2017).
Five States did not conduct required parity analyses across their delivery systems, and eight States did not make parity compliance information available to the public by the compliance date.
States and their MCOs may not have delivered MH/SUD services in parity; MCOs applied financial requirements that were more restrictive for MH/SUD benefits than medical/surgical benefits in two States, and imposed quantitative treatment limits (QTLs) that were more restrictive in six States; all eight had nonquantitative treatment limitations (NQTLs) that wer…
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AI-Assisted
AI Scope Summary
Assess CMS’s oversight of MH/SUD parity compliance in Medicaid managed care across eight States, including contract provisions, parity analyses, public posting, and delivery of parity-compliant services, and provide actionable recommendations to strengthen oversight and ensure timely compliance.
AI-Generated Insight
This audit reveals systemic gaps in CMS and state oversight of parity requirements for MH/SUD benefits in Medicaid managed care, with widespread noncompliance that could impede access to necessary MH/SUD services. The findings underscore the need for stronger CMS leadership, robust state monitoring, and enforceable deadline-driven corrective actions to uphold parity protections and improve access to care.