Before the Affordable Care Act 2010 (ACA) enactment, mental illnesses and substance abuse patients experienced an extremely fragmented care system which was characterized by elevated levels of unmet treatment needs and poor health outcomes. Particularly, such patients have ensured high pervasiveness of preventable health cases, HIV, heart and respiratory diseases and diabetes. The provisions of ACA can address such issues via improving both behavioral as well as physical health care systems. This essay paper reviews the implications of ACA on mental health illness and substance abuse patients.
Enhance Heath Care Access
The ACA stimulates access to care services through Medicaid expansion. Notably, in January 2014, most American citizens aged 65 years old with incomes below 133 percent of the federal poverty threshold became legitimate Medicaid beneficiaries (Croft, & Parish, 2013). In addition, about 32 million people who will be eligible to get insurance cover in the years to come, 5.5 million (or 17.5 percent) are presumed to have substance use disorder or mental illness. In addition, such individuals are anticipated to meet the extended criteria of Medicaid eligibility according to ACA provisions. In a different vein, ACA inhibits insurers from restricting beneficiaries’ yearly and lifetime expenditure on mental illness and substance abuse treatment at a threshold underneath the physical health treatment restriction (Croft, & Parish, 2013). Further, ACA provides for an improved compilation, scrutiny and reporting of data relating to access as well as the treatment of patients with mental illness and substance abuse.
Transform the Financing and Reimbursement in Health Care
Financing and reimbursement changes of ACA have implications on mental health illness and substance abuse disorders through medical homes, accountable care organizations, increased reimbursement of primary care, co-location of primary care and behavioral health services, and, home and community-based services (Croft, & Parish, 2013). In reference to a medical home, the ACA supports the extension of medical homes via experimental programs as well as the creation of Medicaid state plans. In particular, states are in a position to allow Medicaid beneficiaries with severe mental health conditions to have providers act as health homes. In addition, the ACA has expanded the current SAMHSA program. Notably, ACA has provided an extra $50 million in form of grants to integrate and coordinate service within the current community-based behavioral health environment (Druss, & Mauer, 2010). Through basic Medicaid plans, ACA lets state offer community and home-based services. Such plans are in a position to enhance the accessibility of individually based care services which are intended to reduce integration barriers like peer wellness coaches in helping patients to attain their desired goals.
Enhancing Existing Infrastructure
The ACA aims at enhancing existing infrastructure that will have significant implications on mental health illness and substance abuse. For instance, ACA has created a Community-Based Collaborative Care Network Program which has the potential of bolstering behavioral health as well as primary care integration efforts through a partnership with behavioral health service providers (Bao, Casalino, & Pincus, 2013). Considerably, About 60% of disabled individuals who duly qualify for Medicaid and Medicare have mental illnesses face barriers relating to integrated care and insurance systems (Croft, & Parish, 2013). Notably, ACA through Federal Coordinated Health Care Office checks the progress and at the same time provides technical assistance to health practitioners, states and health policies in creating integrated care programs.
ACA has significant implications for mental health illness and substance abuse patients. Such implications are classified into increased access to care service, financing and reimbursing changes, and infrastructure supports. Overall, ACA enables mental health illness and substance abuse patients to have timely access to their desirable medical and health care services.
Bao, Y., Casalino, L. P., & Pincus, H. P. (2013). Behavioral health and health care reform models: Patient-centered medical home, health home, and accountable care organization. J Behav Health Serv Res, 40(1), 121–132.
Croft, B., & Parish, S. L. (2013). Care integration in the patient protection the protection and affordable care act: Implication for behavioral health. Adm Policy Ment Health, 40(4), 1-8.
Druss, B. G., & Mauer, B. J. (2010). Health care reform at the behavioral health-primary care interface. Psychiatric Services, 61(11), 1087-1092.