© Daniel E. Dawes, Esq. “Mental Health and Substance Abuse Care in a Reformed World” January 25, 2014 Families USA 2014 Health Action Conference

 People with SMI die on average 25 years earlier than the general population at 53 years of age. (SAMHSA, 2013).  The suicide rate among American Indians and Alaska Natives (AI/AN) is 50% higher than the national average (HHS, 2001).  Blacks are 30% more likely to report having serious psychological distress (CDC, 2007).  Latino/Hispanic youth experience disproportionately more anxiety-related and delinquency problem behaviors, depression, and substance use (HHS, 1999).  Asian women have the highest suicide rate of all women over age 65 (HHS, 2001).  Lesbian, gay, and bisexual individuals are approximately two and a half times more likely than heterosexuals to have a mental health disorder in their lifetime (Cochran, 2003).  Racial and ethnic minorities experience a greater burden from mental illness (HHS, 2001). Within the same diagnosis, minorities report more severe symptoms and experience more persistent disorders (Breslau, 2006; Williams, 2007; HHS, 2001).  Behavioral health services meet the needs of only 13 percent of racial and ethnic minority children and youth. (Stagman & Cooper, 2010). Despite the fact that minorities are less likely to receive mental health services, when they do access services, those services tend to be ineffective and of low quality. (Cooper & Knitzer, 2008). Behavioral Health Disparities

Racial and ethnic minority groups experience disproportionalities 83,000 deaths per year $300 billion in costs to the country Health disparities are not isolated issues Negative health outcomes and disparate treatment in health care impact the economic and social vitality Policy is a driving force for helping us eliminate health disparities

The Health Reform Law  3 rd Anniversary of the Affordable Care Act  Sweeping changes to health care  Implemented over the next several years in the following areas: Expanded coverage, parity, and MH & SU benefits Data collection & reporting Prevention & wellness including depression and substance use screening Comparative effectiveness research for behavioral health disparities Delivery system reforms, (including PCMH, ACOs, bundled payments) Payment system reforms Workforce development Attack fraud and abuse

 HIE (incentives, navigators, and notices)  Data Collection & Reporting  Behavioral Health Workforce Cultural Competence  Nondiscrimination  Quality Improvement  Nonprofit Hospital Requirements  Prevention and Public Health Fund  Elevating Minority Health in the Federal Agencies – state minority health office

6  National Health Disparities Strategy  National Quality Strategy  National Prevention and Wellness Strategy  National Health Literacy Strategy  Federal HIT Strategy  National HIV/AIDS Strategy

 SAMHSA expects Block Grants to:  Reduce disparities in access, services provided, and behavioral health outcomes among its diverse subpopulations. Grantees should collect and utilize data to:  (1) identify subpopulations vulnerable to health disparities, and  (2) implement strategies to decrease the disparities in access, service use, and outcomes both within those subpopulations and in comparison to the general population.  Submit health disparity impact statements  Support a reduction in disparities relative to limited English proficiency  Provide flexibility in the use of EBPs and alternative practices for minorities.  Prioritize special attention to certain populations.  Services should also take into account ethnic- and culture-specific services for minorities.

 Block Grant funds directed for four areas: ◦ 1. priority treatment and support services for those without insurance or for whom coverage terminated ◦ 2. priority treatment and support services not covered by Medicaid and Medicare, or private insurance ◦ 3. primary prevention: universal, selective, and indicated prevention activities and services ◦ 4. performance and outcome data

◦ Strategic partnerships with diverse stakeholders to ensure inclusion of behavioral health ◦ Ensure that mental health and substance use services are appropriately included in health plans ◦ Ensure mental health and substance use providers are included in networks ◦ Ensure the prioritization of behavioral health equity as states develop and implement their own plans for addressing health inequities

◦ Certified Application Counselors for HIE and healthcare navigators ◦ Cultural and Linguistic Competence Trainings ◦ Incentivizing Health Disparities Reduction Activities ◦ Community Health Needs Assessments ◦ Shared Decision-Making – creating patient decision-making aids ◦ Community Health Workers/Promotoras/Healthcare Navigators ◦ Hospitals will be penalized for preventable readmissions and hospital acquired conditions, could work with hospitals to limit the impact ◦ Hospitals, community health centers, and physicians may participate in shared-savings under ACOs, PCMHs, bundled payments, etc – may be able to provide expertise to them ◦ Create a Patient-Centered Medical Home

 Undocumented Immigrants ineligible for ACA benefits  DACA beneficiaries, despite special status, ineligible for ACA benefits – may still get through employers  Documented Immigrants/Permanent Legal Residents – 5 year waiting period for Medicaid, immediate benefits for HIEs, or through employers.  (Special Note: Permanent Legal Residents below 100% FPL would be eligible for subsidies to purchase coverage via HIE)

“We need advocates who care enough, know enough, do enough, and persist enough” Dr. David Satcher, 16 th U.S. Surgeon General Moving Forward

Questions? For more information, please contact Daniel E. Dawes, Esq. or 13 HEALTH EQUITY FOR ALL!