1. Mental Health America of WI The Promise of Health Care Reform for People with Mental Health and Substance Use Disorders *********************** Shel Gross, MPA Director of Public Policy

2. The Bottom Line We’ve been asking to be treated as first class citizens; ACA does that. -National Council webinar

3. Private Insurance Regulation No pre-existing condition exclusions Guaranteed issue Premiums can’t be based on health status Plans offered on exchanges must include MH/SA benefits at parity

4. Integration Growing recognition that we can’t bend the cost curve without addressing chronic health conditions And We can’t address chronic health conditions without addressing mental health

5. Integration State option for “health homes” for people with SMI; 90% federal funding for 2 years. Post-partum depression campaign. Centers for Excellence on Depression. Prevention services at no cost include depression and substance use screening.

6. Medicaid/Exchanges Allows expansion of Medicaid to 133% FPL with enhanced federal funding. Allows Medicaid to cover non-disabled adults without dependent children. Along with formation of exchanges can reduce the uninsured by more than half.

7. Largest share of Expansion Pop. Are ‘Childless Adults’

8. Prevalence of Behavioral Health Conditions Among Uninsured Adults Ages 18-64 with Incomes <400% FPL

9. MH/SA Prevalence in the Medicaid Expansion Pop. SAMHSA Data: see citation

10. MH/SA Prevalence in the Exchange Population

11. Will the Promise Be Realized?

12. Status of Medicaid Expansion 27 states currently not moving forward or still debating Medicaid expansion. If they don’t expand an estimated 6.4 million fewer people would gain coverage. This represents nearly two-thirds of the potential reduction in the uninsured tied to the expansion. Analysis prepared by the Urban Institute for the Kaiser Family Foundation's Commission on Medicaid and the Uninsured

13. Status of Medicaid Expansion StateStatus IllinoisExpanded to 133% IndianaBuild on Healthy Indiana Plan waiver? MichiganLegislature debating as we speak; not expansion but movement OhioGov. and Leg. at odds; may “extend” MA WisconsinChildless adults to 100%; MA contraction for parents

14. Status of Exchanges

15. Outreach Challenge Even in States with expanded coverage, research has shown that individuals with MH or SU conditions remain disproportionately likely to be uninsured. According to Massachusetts Bureau of SA Services 20-25% of acute service presentations (primarily detox) are uninsured. These are disproportionately young men who are otherwise physically healthy.

16. Citations MH/SA Prevalence Data: 2008-2011 National Survey of Drug Use and Health; 2011 American Community Survey. State Exchange Map: National Academy of State Health Policy.

17. Contact Info Shel Gross Mental Health America of WI 608-250-4368 shelgross@tds.net