Ohio has parity in health coverage between mental illness and physical ailments, right? Not really. As the Center for Community Solutions explains in a recent report, “Pursuit of Parity: Where Ohio stands on insurance coverage of mental illness and substance abuse disorders,” the gap remains disappointingly wide. This is 23 years after Congress enacted the Mental Health Parity Act, and 11 years since lawmakers updated the law. Ohio approved its own parity statute in 2006.

Why have good intentions fallen short across the state? The Cleveland-based think tank reports that part of the problem is a lack of awareness. Patients do not have an adequate grasp of what parity means in terms of the access and treatment they deserve. The report notes that in 2017, the state Department of Insurance received more than 2,500 consumer complaints about health or accident insurance. Just seven involved mental illness or substance abuse.

Another shortcoming goes to the limits of the state parity law. The report points to the “relatively short list of mental illnesses” that are covered. The law does not include substance disorders. In addition, it is structured in a way that gives insurers substantial leverage over reimbursement rates to providers and in limiting access to services and treatment through such practices as prior authorization.

The report cites a finding by Parity at 10, a national advocacy group, that nearly three-quarters of providers in Ohio say their patients encounter insurance-related barriers to accessing mental health and substance abuse services. More, one-third of those providers are not sure how to assist patients in addressing the denials. The report highlights an analysis by Milliman, a research firm, that found Ohioans are up to five times more likely to receive mental health care out of network compared to patients in need of medical or surgical care.

Which gets to the lower reimbursement rates for providers. Milliman found primary care providers and specialists were paid 21 percent and 22 percent more, respectively, than mental health care providers for comparable treatment and services. It follows that lower reimbursement rates translate to fewer providers, and fewer providers mean more care received out of network, which poses financial and access obstacles for patients.

What can be done to achieve real parity? The report stresses the importance of aligning state law with current federal law. An analysis by Parity at 10 identifies 12 separate sections of the Ohio Revised Code that are in conflict with the updated federal statute. Those differences go to availability of care and financial requirements for patients. Federal law is less restrictive, insurers without the same room to limit access, mandates for coverage extending to the full scope of benefits for mental illness and substance abuse.

Ohio would do well to follow Illinois, the report explaining that its coverage protections go beyond federal law in barring prior authorizations and step therapies for medication-assisted treatment for opioid addiction. As the report adds, recent research at Ohio State has found that counties with less access to medication-assisted treatment (therapy combined with medications such as methadone and vivitrol) often have higher rates of overdoses.

Any effort to reach parity must include an education campaign, making patients, families, employers and providers more aware of what such coverage involves and what patients are due. The report rightly advises that getting there requires a much greater degree of coordination among state agencies. One fortunate thing is Gov. Mike DeWine has begun to make the needed push. His RecoveryOhio Advisory Council already has made dozens of recommendations along these lines.

The promise of parity for mental illness was made long ago. The state cannot move too quickly to see it fulfilled.