1. Delaware Health and Social Services NAMI Delaware Conference: January 24, 2013 Rita Landgraf, Secretary, Department of Health and Social Services ACA and Mental Health Care: Closing the Gaps

2. Delaware Health and Social Services Health Care Spending vs. Outcomes Source: United Nations Development Programme Report 2007-2008. Retrieved from www.unnatuaralcauses.org 2

3. Delaware Health and Social Services ACA: Challenge and Opportunity Delawareans benefit from health care reform by: Increased access to health insurance and quality health care, including mental health services. Being supported in community-based settings. Promoting healthy lifestyles.

4. Delaware Health and Social Services Need for Increased Access More than 45 million adults had a mental illness in 2011, according to a federal Substance Abuse and Mental Health Services Administration survey. About 11 million had a serious illness. More than 40% did not get care.

5. Delaware Health and Social Services ACA’s Effect on Providers Primary care re-established as gateway to medical care, including those in need of mental health services. Systems and reimbursements will focus on patient outcomes and measurable standards. Must transition from what Gov. Markell calls a “sick care system” to one that encourages positive outcomes and healthy behavior.

6. Delaware Health and Social Services ACA’s Effect on Providers Concern about geographic distribution of primary care providers, especially in underserved and rural areas, including Sussex. For each member, the MCO must have a PCP available within 30 minutes or 30 miles of residence. Every 2,000 patients = 1 PCP

7. Delaware Health and Social Services Data on Primary Care Physicians The 2011 Primary Care Physicians in Delaware report found: 888 active PCPs (FTE = 707 physicians; that’s down from 736 in 2008) Population to provider ratio = 1,274 to 1 (up from 1,187 to 1 in 2008; capacity = 2,000) 86% accept new patients, but only 69%- 70% accept new Medicare & Medicaid clients

8. Delaware Health and Social Services Patient-Centered Medical Homes Transforms the organization and delivery of primary care. The practice treats the “whole” patient, including physical and mental health needs, coordinating care with specialists, hospitals, and home- and community- based care. Convenient hours and secure communication organized around patient.

9. Delaware Health and Social Services Health Benefit Exchange Delaware’s HBE must go live by Jan. 1, 2014; enrolling clients by October 2013. Pursuing a state-federal exchange partnership option rather than create a state exchange. Partnership option permits Delaware to maintain control of plan management and consumer assistance functions.

10. Delaware Health and Social Services ACA: Medicaid Expansion In January 2014, Delaware will widen eligibility up to 138% of the federal poverty level ($15,415 for an individual; $31,809 for a family of four). State expects to cover an additional 20,000 to 30,000 Delawareans. Federal government will pay 100% of the cost for newly eligible clients from 2014-2017; phased down to 90% of costs by 2020.

11. Delaware Health and Social Services Why Medicaid Is Important Medicaid is the largest payer for mental health services in the U.S. It accounts for 27% of all expenditures for mental health services. Individuals with mental health disorders represent 11% of the individuals enrolled in Medicaid. And they represent almost 30% of all Medicaid expenditures.

12. Delaware Health and Social Services Use of Health Care Services Almost 12 million ER visits in 2007 involved people with a mental disorder, substance abuse problem or both. Almost one-fourth of hospital admissions are associated with a mental or substance abuse disorder. Medicaid coverage can help with access.

13. Delaware Health and Social Services Among Goals for Coverage Be able to identify and treat mental illness and substance abuse disorders in order to improve overall health. Services and programs should be person-centered and support health, recovery and resilence of individuals. Individuals and families should have choice. Services should be of high quality and consistent with clinical guidelines or evidence-based practices. Services should maximize community integration.

14. Delaware Health and Social Services Mental Health Goals of ACA Screen for mental and substance abuse disorders, including those in children. Increase access to behavioral health services for people with serious and/or chronic disorders. Improve integration of primary care and behavioral health.

15. Delaware Health and Social Services Mental Health Parity Act The 2008 act ended differences for benefits for people dealing with mental illness or substance abuse. Health plans could not charge higher co-pays or deductibles for mental health services or place tighter limits on the number of therapy visits. Protections applied only to health plans offered by large employers. In 2014, ACA extends benefits to plans offered by small employers and those that individuals buy. Medicaid and CHIP will have to offer equivalent mental health benefits.

16. Delaware Health and Social Services Delaware’s Workforce Needs Delaware’s aging population, health care reform, and additional insured clients under Medicaid expansion and health benefit exchange will increase demands on health professionals. To deal with shortage: Encourage nurse practitioners to practice to top of licenses, using prescriptive authority. Electronic medical records: As of July, 95% of providers enrolled in the DHIN.

17. Delaware Health and Social Services Delaware’s Workforce Needs Delaware experiencing shortages among mental health providers, especially in Kent and Sussex. Use State Loan Repayment Program to attract professionals. Telehealth will help extend resources, especially for specialty care, including telepsychiatry. As of July 1, Medicaid now reimburses for telehealth-delivered care.

18. Delaware Health and Social Services Community-Based Services The right care in the right place at the right time. For mental health care, it means: Receiving care in the most integrated and least restrictive setting possible. 24/7 mobile crisis and mental health screeners. Drop-in centers and peer support services. State Rental Assistance Program to help with housing and increased employment opportunities. HB311, reforming Delaware’s emergency mental health detainment law. HJR17, creating a study group to review the state’s civil mental health laws.

19. Delaware Health and Social Services YOUR TURN What is important to you relative to mental health care, state government and the next term?

20. Delaware Health and Social Services