ACA and Mental Health Care: Closing the Gaps

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ACA and Mental Health Care Closing the Gaps
NAMI Delaware Conference January 24, 2013Rita
Landgraf, Secretary, Department of Health and
Social Services
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Health Care Spending vs. Outcomes
Source United Nations Development Programme
Report 2007-2008. Retrieved from
www.unnatuaralcauses.org
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ACA Challenge and Opportunity

• Delawareans benefit from health care reform by
• Increased access to health insurance and quality
  health care, including mental health services.
• Being supported in community-based settings.
• Promoting healthy lifestyles.

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Need for Increased Access

• More than 45 million adults had a mental illness
  in 2011, according to a federal Substance Abuse
  and Mental Health Services Administration survey.
• About 11 million had a serious illness.
• More than 40 did not get care.

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ACAs Effect on Providers

• Primary care re-established as gateway to medical
  care, including those in need of mental health
  services.
• Systems and reimbursements will focus on patient
  outcomes and measurable standards.
• Must transition from what Gov. Markell calls a
  sick care system to one that encourages
  positive outcomes and healthy behavior.

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ACAs Effect on Providers

• Concern about geographic distribution of primary
  care providers, especially in underserved and
  rural areas, including Sussex.
• For each member, the MCO must have a PCP
  available within 30 minutes or 30 miles of
  residence.
• Every 2,000 patients 1 PCP

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Data on Primary Care Physicians

• The 2011 Primary Care Physicians in Delaware
  report found
• 888 active PCPs (FTE 707 physicians thats
  down from 736 in 2008)
• Population to provider ratio 1,274 to 1 (up
  from 1,187 to 1 in 2008 capacity 2,000)
• 86 accept new patients, but only 69-70 accept
  new Medicare Medicaid clients

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Patient-Centered Medical Homes

• Transforms the organization and delivery of
  primary care. 
• The practice treats the whole patient,
  including physical and mental health needs,
  coordinating care with specialists, hospitals,
  and home- and community-based care.
• Convenient hours and secure communication
  organized around patient.

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Health Benefit Exchange

• Delawares HBE must go live by Jan. 1, 2014
  enrolling clients by October 2013.
• Pursuing a state-federal exchange partnership
  option rather than create a state exchange.
• Partnership option permits Delaware to maintain
  control of plan management and consumer
  assistance functions.   

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ACA Medicaid Expansion

• In January 2014, Delaware will widen eligibility
  up to 138 of the federal poverty level (15,415
  for an individual 31,809 for a family of four).
• State expects to cover an additional 20,000 to
  30,000 Delawareans.

Federal government will pay 100 of the cost for
newly eligible clients from 2014-2017 phased
down to 90 of costs by 2020.
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Why Medicaid Is Important

• Medicaid is the largest payer for mental health
  services in the U.S.
• It accounts for 27 of all expenditures for
  mental health services.
• Individuals with mental health disorders
  represent 11 of the individuals enrolled in
  Medicaid.
• And they represent almost 30 of all Medicaid
  expenditures.

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Use of Health Care Services

• Almost 12 million ER visits in 2007 involved
  people with a mental disorder, substance abuse
  problem or both.
• Almost one-fourth of hospital admissions are
  associated with a mental or substance abuse
  disorder.
• Medicaid coverage can help with access.

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Among Goals for Coverage

• Be able to identify and treat mental illness and
  substance abuse disorders in order to improve
  overall health.
• Services and programs should be person-centered
  and support health, recovery and resilence of
  individuals.
• Individuals and families should have choice.
• Services should be of high quality and consistent
  with clinical guidelines or evidence-based
  practices.
• Services should maximize community integration.

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Mental Health Goals of ACA

• Screen for mental and substance abuse disorders,
  including those in children.
• Increase access to behavioral health services for
  people with serious and/or chronic disorders.
• Improve integration of primary care and
  behavioral health.

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Mental Health Parity Act

• The 2008 act ended differences for benefits for
  people dealing with mental illness or substance
  abuse.
• Health plans could not charge higher co-pays or
  deductibles for mental health services or place
  tighter limits on the number of therapy visits.
• Protections applied only to health plans offered
  by large employers.
• In 2014, ACA extends benefits to plans offered by
  small employers and those that individuals buy.
  Medicaid and CHIP will have to offer equivalent
  mental health benefits.

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Delawares Workforce Needs

• Delawares aging population, health care reform,
  and additional insured clients under Medicaid
  expansion and health benefit exchange will
  increase demands on health professionals.
• To deal with shortage Encourage nurse
  practitioners to practice to top of licenses,
  using prescriptive authority.
• Electronic medical records As of July, 95 of
  providers enrolled in the DHIN.

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Delawares Workforce Needs

• Delaware experiencing shortages among mental
  health providers, especially in Kent and Sussex.
• Use State Loan Repayment Program to attract
  professionals.
• Telehealth will help extend resources, especially
  for specialty care, including telepsychiatry. As
  of July 1, Medicaid now reimburses for
  telehealth-delivered care.

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Community-Based Services

• The right care in the right place at the right
  time. For mental health care, it means
• Receiving care in the most integrated and least
  restrictive setting possible.
• 24/7 mobile crisis and mental health screeners.
• Drop-in centers and peer support services.
• State Rental Assistance Program to help with
  housing and increased employment opportunities.
• HB311, reforming Delawares emergency mental
  health detainment law.
• HJR17, creating a study group to review the
  states civil mental health laws.

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YOUR TURN

• What is important to you relative to mental
  health care, state government and the next term?

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