Affordable Care Act tagged posts

Carol McDaid
Parity Implementation Coalition

CFYM Note: Many people wonder if their health insurance will cover costs for mental health hospitalization, therapy and medication. Read this first post in a series by Carol McDaid that explains your rights concerning equal insurance benefits in relation to physical and mental disorders.

Hint: Our work isn’t over

As a person living in recovery, I know firsthand the struggles people face when seeking mental health and addiction benefits. I understand what it’s like to be sick and in desperate need of treatment, told by my employer I had to go to treatment, but denied care by an insurance company.

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On Tuesday, inspired by Labor Day, we looked at three mental health policy issues for employees. One of those was the declining number of people who have health insurance through their work.

What are the ramifications for people who do not have employer-sponsored health insurance?

Today, two members of the CFYM community describe their struggles to access mental health care services in the absence of employer-sponsored health insurance. After her health insurance through COBRA ran out, Janet faced the prospect of highly-restrictive coverage, then no coverage...

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William Tomasko
Enroll America

Start your timer. Count down the days. Open enrollment is coming. On October 1, consumers will be able to start signing up for the new health coverage options under the Affordable Care Act (ACA)—and there will be new opportunities for them to get help finding quality, affordable plans.

Our organization, Enroll America, is a nonprofit, non-partisan 501(c)3 dedicated to spreading the word about Americans’ new health coverage options. Working with our broad array of partners, we’re helping consumers get the facts about how they can get covered and engaging the entire health care community as we all mobilize for enrollment.

Out of those who reported having an unmet need for mental health care in 2011, nearly two-thirds said they went without care because they couldn’t afford it or because their health insurance either wouldn’t cover it at all or insufficiently covered it, according to data from the Substance Abuse and Mental Health Services Administration.

And around 30% of those who will soon be eligible for financial help through health insurance marketplaces or from expanded Medicaid have a mental illness or a substance use disorder. In total, around 11 million in need of mental health and substance use disorder care could benefit from newly enrolling in coverage this fall.

Getting these individuals enrolled will take one of the biggest outreach and public education efforts ever undertaken in the history of public health coverage programs. Why? Our research reveals that 78% of the uninsured don’t know (yet) about the coming coverage options. Our findings point to some of the most important messages to use to compel people to enroll, and the effective ways to reach them.

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The Network for Public Health Law outlines a unique opportunity for consumers, families, and advocates to bring attention to local mental health needs. Every nonprofit hospital is required to participate. Chances are there’s a nonprofit hospital—and a chance to be involved—near you!

Identify and Address Mental Health Needs in Your Community

Corey Davis & Andy Baker-White
Network for Public Health Law

The majority of American hospitals are recognized as nonprofit organizations under state and federal law. This permits them to receive a number of financial benefits, including an exemption from the federal income tax. Many states and municipalities also provide nonprofit hospitals with exemptions from property, sales, and other taxes. This favorable tax treatment comes with the responsibility that these hospitals provide certain benefits to the communities they serve.

Community Health Needs Assessment

The Patient Protection and Affordable Care Act (ACA) contains a provision that requires each nonprofit hospital to conduct an assessment of the health needs of its community in order to better understand and help meet those needs. This assessment, known as a Community Health Needs Assessment (CHNA) must be conducted every three years and made widely available to the public. Groups and individuals working in, or advocating for, mental health may take advantage of the CHNA to collaborate with hospitals to help determine whether mental health is a health need for the community.

When conducting the CHNA, the nonprofit hospital is required to collect input from people who “represent the broad interests of the community served” by each hospital facility. Under proposed IRS rules, the hospital must take into account input from the following sources, among others:

• at least one state, local, tribal, or regional governmental public health department with knowledge, information, or expertise relevant to the health needs of that community;
• members of medically underserved, low-income, and minority populations in the community, or individuals or organizations serving or representing the interests of such populations; and
• written comments received on the hospital facility’s most recently conducted CHNA and most recently adopted implementation strategy.

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In 2008, the U.S. House of Representatives recognized the need to bring attention to issues around mental health awareness among, and mental health care for, the nation’s minority communities. To further those issues, the House passed a resolution in support of Bebe Moore Campbell National Minority Mental Health Awareness Month.

The implementation of the Affordable Care Act (with the open enrollment period beginning on October 1, 2013) should help address one of the issues outlined in the resolution: the fact that many minority mental health consumers are underinsured or uninsured, and thus receive a diagnosis late in their illness, if at all.

But what about the other issues?

Top 5 Issues Related to Minority Mental Health

Here are Care for Your Mind’s top 5 issues related to minority mental health awareness that remain to be addressed. (All quotes are from the text of the resolution.)

1. Disproportionate access to services:“adult Caucasians who suffer from depression or an anxiety disorder are more likely to receive treatment than adult African Americans with the same disorders even though the disorders occur in both groups at about the same rate, when taking into account socioeconomic factors”

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Senator David Carlucci
Chair, Committee on Mental Health and Developmental Disabilities
New York State Senate

On this blog a few days ago, Andrew Sperling of the National Alliance on Mental Illness raised questions about access to mental health treatments under the Affordable Care Act (ACA); and he voiced concerns about people being able to receive the specific mental health drugs they require once the health reform law is implemented.

As Mr. Sperling pointed out, restricting access to a full class of drugs and limiting prescribers’ option to one drug per class—which health plans can opt to do under ACA—can be short-sighted from an economics standpoint and disastrous from a health perspective. Without access to clinically appropriate medication, individuals with mental illness have higher rates of emergency room visits, hospitalization and other health services.

As Chair of the New York State (NYS) Senate Committee on Mental Health and Developmental Disabilities, I understand that in order to manage the health of people living with serious mental illness, patients need guaranteed access to the full range of drugs and services that are most likely to improve their health. Even more important, I recognize that no one understands a patient’s needs better than his or her healthcare provider; and it’s presumptuous—if not irresponsible—to remove decision-making authority from that provider.

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Andrew Sperling, Director of Legislative Advocacy
National Alliance on Mental Illness (NAMI)

The Patient Protection and Affordable Care Act (ACA) offers new choices for quality, reliable, low cost private health insurance and opens Medicaid to more people living with mental illness.

Under the law, all health plans are required to provide certain categories of benefits and services—so-called Essential Health Benefits (EHB). One of these is prescription drugs.

A question mark as to prescription drug coverage
While plans will be required to cover a minimum number of prescription drugs used to treat mental health conditions in a therapeutic class, each plan may choose to cover different medications; and the number of covered drugs will vary by state and by plan.  Most significant, the law does not require plans to cover all drugs in a particular therapeutic class.  As a result, medical and behavioral health plans can avoid covering specific drugs that, in your physician’s judgment, best address your needs.

This poses serious challenges for individuals who are in need of multiple drugs per class, particularly people with serious and persistent mental illness, chronic conditions and disabilities. Antipsychotic medications, for example, are not clinically interchangeable, and providers must be able to select the most appropriate, clinically indicated medication for their patients.  What’s more, physicians may need to change medications over the course of an illness as patients suffer side-effects or their illness is less responsive to a particular drug, and patients requiring multiple medications may need access to alternatives to avoid harmful interactions.

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Ron Manderscheid, Ph.D.
Executive Director, NACBHDD

If you or a family member needed care today for a mental health or substance use condition, would you be able to get it? Mental health and substance use conditions, like depression or inappropriate use of alcohol, are real, treatable health problems. As with other health problems (like diabetes, high blood pressure, or heart disease), people with mental or substance use conditions can lead healthy, productive lives when the health problem is diagnosed and treated. When identified and treated early, the severity and impact of these health issues, including damaging consequences to both the person being treated and her or his family, can be reduced. That’s why the process of getting care—what we refer to as gaining access—is critically important.

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