DC Health Benefit Exchange Authority Makes it Easier for Children to Access Mental and Behavioral Health Services

Executive Board votes to cut copays to $5, no deductibles

Washington, DC–The DC Health Benefit Exchange Authority (DCHBX) Executive Board unanimously voted to adopt recommendations based on the work of the DCHBX Standard Plans Working Group to help address health disparities in pediatric mental health treatment. Starting in Plan Year 2024, children covered by a standard plan on DC Health Link will only have a $5 copay, with no deductibles, for outpatient mental health visits, including specialist visits, and no limit on the number of visits. Additionally, this vote reduces prescription copays for child mental health care to $5, with no deductibles.

The action taken by DCHBX means that parents who had copays as high as $45 for their children's mental health visits will only pay $5 starting in 2024. Additionally, parents who were paying as high as $25 in copays for even the lowest-cost generic prescriptions for their children, will have only a $5 copay starting in 2024.

“Study after study shows that children of color are less likely to receive mental health services they desperately need,” said Diane C. Lewis, M.P.A., Chair of the DCHBX Executive Board and Chair of the DCHBX Social Justice and Health Disparities Working Group. “We know we have to reach these children early to make the greatest impact on their health and well-being, which is why advancing equity is crucial in the District of Columbia.”

DCHBX’s work comes at a time the American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry, and Children’s Hospital Association have declared a national emergency in child and adolescent mental health, citing inequities resulting from structural racism as having contributed disproportionate impacts on children of color. Local clinical experts from Children’s National Hospital and Whitman Walker Institute supported the extensive work of the HBX Standard Plan Working Group comprised of DC Health Link insurers, consumer advocates, brokers, and others.

"I think we've done something important here. Eliminating financial barriers for children to get the mental and behavioral health services they need will make a huge positive impact," said Dr. Leighton Ku, Chair of the DCHBX Standard Plans Advisory Working Group and Member of the DCHBX Executive Board. “This action is the latest example demonstrating how the District of Columbia is a national leader in advocating for its customers."

This action is the latest step DCHBX has taken to implement policy changes outlined by the DCHBX Social Justice and Health Disparities Working Group designed to stop systemic racism in health care. Last year, DCHBX eliminated cost sharing for the treatment of Type 2 diabetes in DC Health Link standard plans. The District of Columbia is the first state-based marketplace to take such a broad approach. The DCHBX Executive Board established the Social Justice and Health Disparities Working Group in the fall of 2020. In July 2021, the DCHBX Executive Board voted to adopt recommendations from the Social Justice and Health Disparities Working Group to establish practices, structures, and policies to be implemented by DCHBX and DC Health Link health plans to (1) expand access to providers and health systems for communities of color, (2) eliminate health outcome disparities for communities of color, and (3) ensure equitable treatment for patients of color in health care settings and in the delivery of health care services.

The DCHBX Executive Board resolution lowering copays for pediatric mental and behavioral health conditions is available here.

There are 100,000 people and more than 5,300 employers with private health insurance coverage through DC Health Link. DCHBX is responsible for DC Health Link – the Affordable Care Act online health insurance marketplace in DC. For more information on the 2021 recommendations made by the Social Justice and Health Disparities Working Group and adopted by the HBX Executive Board, click here.

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