More states advancing PTSD coverage for first responders

June 25, 2021 · Public Policy & Regulatory Affairs Team

As we emerge from the COVID-19 pandemic, Post-Traumatic Stress Disorder (PTSD) presumption coverage for first responders and other “essential” workers continues to be a popular topic during the 2021 legislative season. In 2020, along with presumptions related to COVID-19, we saw states move forward with policies to expand and/or create new coverage, or approve treating conditions previously not considered compensable, such as PTSD. Now, even more states are evaluating the need to expand coverage to treat PTSD for first responders and other impacted workers such as healthcare workers and 911 dispatchers.

PTSD, a mental health condition often triggered by a traumatic event or continued exposure to high levels of stress or traumatic events, continues to garner interest in the first responder community. Police officers, firefighters, paramedics and frontline healthcare workers are often exposed to high stress level situations or traumatic events during the course of their employment.

States add PTSD coverage

To date in 2021, Nebraska, Wisconsin and West Virginia passed legislation related to PTSD as a covered condition. Similar legislation is on hold in California, Oklahoma and New York, while comparable legislative efforts failed in other states. This expands the number of states addressing PTSD by legislative effort while other states examine potential regulatory developments. More than 50% of states have enacted PTSD policies or policy changes since 2018.

New type of care creates future uncertainties for employers and payers

Although first responders welcome attention to PTSD and expanded work comp-related coverage, some in-state and municipal governments are concerned about future costs for expanded coverage. While treatment of PTSD is sorely needed, the addition of PTSD coverage for this select group of state/municipal employees introduces a new arena of care, which is less focused on the traditional physical treatment of workers’ comp care and is more focused on mental health treatment. Our 2020 PTSD Awareness Day blog has a clinical perspective, including the Optum Behavioral Health Supplemental Formulary.

Recommendation for clients

As states expand or include PTSD as a compensable condition, Optum urges clients who provide coverage for first responders to learn more about the condition, as well as the treatments and various medications which are commonly utilized to treat PTSD.

Should you have questions on this or any other policy, please contact our Public Policy and Regulatory Affairs team at OWCApolicymatters@optum.com