Healthcare Reform Impact The Road Ahead John O’Brien Senior Advisor on Healthcare Financing

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

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.

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