1. Mission: Protect the Vulnerable, Promote Strong and Economically Self- Sufficient Families, and Advance Personal and Family Recovery and Resiliency. Charlie Crist, Governor George H. Sheldon, Secretary

2.  The Patient Protection and Affordable Care Act referred to as the ACA will significantly change Medicaid services to children and families in Florida  Parents and children under 133% of the Federal Poverty Level will be Medicaid eligible. 2

3.  Subsidies will also be available to families and individuals between 133% and 400% of poverty to purchase insurance through state operated/managed Exchanges  Medicaid and commercial insurance plans accessed through the Exchanges must cover Essential Benefits  Outreach and coordinated eligibility determination will be necessary to ensure children and families access Medicaid 3

4.  Eliminates Pre-existing coverage exclusions for children this year.  Extends the Children’s Health Insurance Program until 2015  Expands preventive care 4

5.  This year eliminates all lifetime limits on coverage.  Includes initiatives to expand primary care  Extends dependent coverage up to 26 years of age  Extends Medicaid coverage for children out of foster care to 26 years of age 5

6.  Passed in 2008, requires that employers with over 50 employees provide for parity when the insurance covers mental health and/or substance abuse services  The Act does not mandate coverage for behavioral health care  Parity addresses financial requirements, limitations of services, and out of network services 6

7.  However, the Essential Benefit, defined for ACA, will include substance abuse and mental health  All plans under the Exchanges and Medicaid Managed Care will have substance abuse and mental health coverage and must meet Parity 7

8.  Expansion of Medicaid coverage to up to 133% of Federal Poverty Level will result in health care coverage for most parents in the system.  Access to health care, substance abuse and mental health services will be significantly increased. 8

9. Example of impact- shift in Medicaid eligibility for services for persons receiving substance abuse treatment. Shift in Medicaid eligibility for persons receiving services 9

10.  The ACA creates grant opportunities over a five-year period to implement evidence-based home visiting programs for families with young children.  Goal is to reduce infant and maternal mortality but should also reduce child abuse and neglect. 10

11.  Grants address improvements in:  Prenatal care  Maternal and newborn health  Child health and development  Parenting skills  School readiness  Reduction of juvenile delinquency  Improved economic self-sufficiency 43

12.  “At risk” eligible families include characteristics such as :  families with a history of child abuse or neglect or have had interactions with the child welfare system  families with a history of substance abuse or need substance abuse treatment 12

13.  11 billion dollars in grants will be available to Federally Qualified Health Care Centers over the next 5 years.  FQHCs provide health care, and dental care.  New and expanded FQHCs are required to provide some behavioral health care services. 13

14.  Integration of Primary Care and Behavioral Health Care will be necessary to implement ACA.  Partnerships between the Behavioral Health Care providers and FQHCs are developing now.  Primary Care providers will begin to screen for behavioral health care conditions. 14

15.  ACA has a focus on prevention and management of chronic disease.  Many persons with mental and substance use disorders have a chronic disease and co-morbidity.  Partnerships with primary and behavioral health care must address chronic care. 15

16.  In the future, it may be possible to refer families to a FQHC and have screenings completed for medical, developmental, and behavioral health care conditions.  FQHCs and other primary care sites are developing medical homes for children and families. 16

17.  ACA provides us with an opportunity to develop medical homes for children in families with multiple risks.  Medical homes can assist us in providing health care to children in foster homes and can help provide continual and coordinated medical care. 17

18.  Medical homes can serve as partners in our work to reduce abuse and neglect and promote family preservation.  ACA expands Medicaid eligibility for youth leaving foster care up to the age of 26.  Youth can remain in their medical home which will promote continuity of health care. 18

19.  ACA provisions in Medicaid will be implemented through managed care.  Medicaid reform will impact how ACA will be provided in Florida.  It is very likely that Florida will require integrated managed care plans that include medical and behavioral health. 19

20.  ACA promotes the development of new payment methods that promote quality of care  Payment methods that address outcomes and costs will be explored.  Accountable Care Organizations may be one avenue to achieve pay for performance type health care plans. 20

21.  Children and families will have expanded access to Medicaid and commercial insurance coverage.  Interventions and treatment for mental and substance use disorders will be available through Medicaid. 21

22.  Primary care will be expanded and will include a stronger emphasis on prevention.  The combination of Parity and ACA will ensure that mental health and substance abuse services are included in the essential benefit plan.  ACA supports other prevention initiatives such as the home visiting program. 22

23.  Federally Qualified Health Care Centers will expand both in the number of sites and amount of services provided.  Partnerships with Federally Qualified Health Care Centers and behavioral health care programs are emerging.  This provides opportunities to develop comprehensive medical homes for children and families with multi-risks. 23