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What’s Been Done So Far?
• Approaching 270 Days Since Affordable Care Act was passed. Changes have focused on:– Significant Program Changes and
Demonstration Projects for Medicaid Recipients –Major Insurance Reform
What’s Been Done So Far?
• What Changes Have Affected Publicly Insured Individuals?– States can receive federal matching funds now for
covering low-income individuals and families– 1M “donut hole” checks to Medicare individuals – Round 2 of Money Follows the Person—heavy
focus on behavioral health– Health Homes for Individuals with Chronic
Conditions
What’s Been Done So Far?
• What Changes Have Affected Publicly Insured Individuals?– Medicaid 1915i Redux—very important changes– Prevention Trust Funds Awarded– Expansion of the number of Community Health Centers—
serving 20 million more individuals– Loan forgiveness programs for primary care, nurses and
even some behavioral health professionals– Increased payments to rural health providers
–
What’s Been Done So Far?
– Major Changes For Individuals Who Are Insured:• Extending coverage to young adults• Providing free preventive care• Ability to appeal coverage determinations• No lifetime limits on benefits• Prohibiting pre-existing coverage for children• Up to 4 million small businesses are eligible for tax
credits to help them provide insurance benefits to their workers • Holding insurance companies accountable for
unreasonable rate hikes
Affordable Care Act
• Major Drivers – More people will have insurance coverage– Medicaid will play a bigger role in MH/SUD than ever
before– Focus on primary care and coordination with specialty care– Major emphasis on home and community based services
and less reliance on institutional care– Preventing diseases and promoting wellness is a huge
theme
Coverage
Enrollment• 32 million individuals—volume issues for 2014• Skepticism—many haven’t been enrolled—
historical message that you will never be covered
• Challenges—doors to enrollment and challenging enrollment processes
• Churning
Primary Care Integration
• Why?– 12 M visits annually to ERs by people with
MH/SUD– 44% of all cigarette consumption by individuals
with MH/SUD– 70% of individuals with significant MH/SUD had at
least 1 chronic health conditions, 45% have 2, and almost 30% have 3 or more
Long Term Care
• MH/SUD systems provide LTC– Multiple admission across years– Some states spend 75% of available public funding
on institutional services– Short term residential = long term residential
(90+)– Long term residential = long term care (2 years+)
So What’s Next?
• Major Changes Will Occur in January 2014– Expanded Medicaid eligibility for 8 million individuals– An additional 8 million will be covered by state
health insurance exchanges– Much work Between Now and Then:
• National Quality Strategy—next month• Community First Option—expanding home and
community based services in 2011• Development of State Health Insurance Exchanges
So What’s Next For SAMHSA?
• Changes are Proposed for Block Grants– Addendum:– Identify needs and priorities for individuals who need BH
services– Identify services that are needed that won’t be purchased by
insurance (including Medicaid)– Managing resources—looking at utilization patterns of
community and LTSS– Focus on developing more opportunities for person centered
planning and participant directed care– Making sure other partners are at the table (Medicaid, local
housing authorities, etc.
So What’s Next For SAMHSA?
• Consultations Regarding Health Homes– Making sure state MH and SA directors are
involved in that process– Focus states efforts on identifying MH/SUD needs
(screening, brief intervention)– Developing models, outcomes and financial
strategies www.samhsa.gov/healthReform/healthHomes
So What’s Next For SAMHSA?
• Service Coverage– Identifying and agreeing on what are good and
modern services– Identifying the evidence that supports these
services– Identifying new services and approaches that
should be introduced and tested
So What’s Next For SAMHSA?
• Enrollment– Identifying strategies that will help people know
their benefits, how to enroll and stay enroll.
• Provider Support– Assistance with Selecting Electronic Health Records– Billing– Compliance– Practice Changes
What Are The Implications for Housing and Homelessness
• Being consistent and clear about what services work for the individuals served by your grantees
• Mapping where these services are covered—where are the gaps
• Understanding the current vehicles that your state could use to address the gap (1915i/MFP/Rebalancing Initiatives)
• Helping states with tough choices about what they need buy
What Are The Implications for Housing and Homelessness
• Insurance Eligibility– Don’t wait until 2014– Perseverance regarding current eligibility avenues
—many people are eligible but not enrolled– Outreach strategies for enrollment that will work
for this population – Discussing with states the possibility of suspended
eligibility
What Are The Implications for Housing and Homelessness
• Primary Care Opportunities—Help folks get to:– Community health centers—more focus on
identifying and treating BH conditions– Health homes—SMI and SUD a critical focus for
individuals with chronic conditions– Will require the ability to describe what these
initiatives are—what is a PCP, how do I get an appointment etc.
How Can I Stay Informed?
• Surf: http://www.healthcare.gov. • Watch a Movie:
http://www.healthcare.gov/news/videos/index.html
• Participate: http://www.healthcare.gov/center/councils.
• Write: www.regulations.gov.