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MHA's Role in the Affordable Care Act
The Challenges of Realizing the Promise of the Affordable Care Act (ACA) for People with Mental Health & Substance Use Conditions
While the ACA holds incredible promise for people with mental health and substance use conditions, but this promise will not be realized if eligible individuals do not enroll or if the federal government and the states do not hold plans accountable for providing necessary and appropriate “essential health benefits” as defined in the Act.
SAMHSA identified a number of barriers to individuals with mental health and substance use conditions enrolling in Medicaid or plans in the Marketplace:
- Unfamiliarity with health insurance and its value
- Lack of awareness that they are eligible
- Cost concerns (premiums, co-pays and deductibles)
- Distrust of government programs
- Lack of decision-making skills
- Churn (individual moving on and off Medicaid)
- Uncovered services; exclusion for preexisting conditions
- Individuals with substance use disorders (SUD) new to health care system
- Complicated enrollment process
Additionally, we know that health plans have not always provided services as required under the Mental Health Parity and Addiction Equity Act. Advocacy is required to ensure this happens.
MHA Roles to Help Realize the Promise of the ACA
There are a variety roles that Mental Health America affiliates (MHAs) can play to both facilitate enrollment of individuals into insurance, either through Medicaid or the Marketplaces, and to ensure that promised consumer protections are realized:
- Some MHAs have become Navigators, organizations selected by the federal government to assist consumers to access insurance through the Marketplace. The competitive application process to become Navigators is completed for now.
- MHAs can identify the Navigators in their states and develop relationships with them. MHAs can help Navigators understand how best to assist persons with MI and SA disorders and attune them to the issues that are likely to be of greatest concern to this population (e.g., the importance of identifying the plan formularies to ensure that individuals can maintain their current medications if they wish to do so).
- MHAs can apply to become Certified Application Counselors (CACs). CACs will have a role similar to Navigators but are not paid through a federal contract. MHAs that have been in positions of assisting people to access health care benefits will be especially well positioned to serve in this role. CACs require specific training to assist people to access plans in the Marketplace.
- MHAs can provide outreach to persons with MI and SA disorders through their programs and partnerships. MHAs can educate themselves to understand how best to direct consumers to those that can assist them and have information materials in their offices and on their websites.
- MHAs can advocate to ensure that the essential health benefits contain a broad array of MH/SA services to support recovery. They can advocate to ensure that consumers are receiving MH/SA services at parity with other medical services
Mental Health America (MHA) is a powerful voice for change that is made up of thousands of individuals nationwide who take an active role in protecting America’s mental health through legislative advocacy. Our health care reform webpage can link you to a variety of resources.
- Health care reform presentations from our 2013 annual meeting.
- Our health care reform toolkit.
- Summary of our issue forums on health care reform.
- Links to webinars, including:
- Affordable Care Act 101: The Basics and Mental Health Components of the Health Reform Law
- Medicaid Expansion Basics: A Coalition for Whole Health Webinar
- The Affordable Care Act (ACA) and Health Plans: Aiding Enrollment in State and Federal Insurance Programs
- Expanding What? Medicaid Benefits Under Health Care Reform
- The Waterfall Effect: Transformative Impacts of Medicaid Expansion for Uninsured People with Mental illness Webinar
- Coalition for Whole Health (CWH), partner of MHA webinar: State-based Advocacy for Essential Health Benefit Design for Mental Health and Substance Use Disorders
- Peer Services: Challenges and Opportunities in Health Care Reform
MHA also has a variety of Position Statements relevant to our work on health care reform.
This fact sheet was prepared by Regional Policy Council member Shel Gross, from the Mental Health America of Wisconsin. To support the work of Mental Health America of Wisconsin, donate here.