A long literature examines the problem of adverse selection in health insurance. Selection occurs when, faced with a choice of health plans with similar premium prices, the sickest and costliest patients disproportionately select plans with richer benefits (4). This problem may be greater for mental health than for other types of conditions, because patients with mental illness tend to have high, persistent medical and behavioral care spending; in insurance terms, they are “bad risks” (5). Because people with mental illness know they are very likely to have an extensive health care need in the upcoming year, they choose more generous plans. In the short term, this “adverse selection” places these plans at a financial disadvantage. Faced with this situation, plans may subsequently raise premiums to the point that they deter healthier, lower-cost individuals, perpetuating the problem. To avoid adverse selection, plans deter enrollment of people with mental illness by limiting behavioral health benefits. In the long term, adverse selection is therefore a problem for patients with mental health needs, who over time face an increasingly limited range of plans from which to choose.