Two significant inclusions in the new health care law could mean more access to care for those living with mental illness.
Under the Affordable Care Act, mental health and substance abuse services are covered and classified under the 10 “Essential Health Benefits.”
Insurance policies are required to cover these benefits in order to be certified and offered in the Health Insurance Marketplace. States expanding their Medicaid programs are required to provide these benefits to people newly eligible for Medicaid.
Angela Minicucci, spokesperson for the State Department of Community Health, said expanding legislation such as the ACA will help almost 500,000 individuals statewide access treatment.
“It’s time to look at the mental health care system and see how it’s working,” Minicucci said. “In the past, a lot of people didn’t seek care because a lot of them didn’t have the coverage to do so.”
In 2013, Gov. Rick Snyder issued an order to create the Mental Health and Wellness Commission. The commission released its 2013 report detailing the findings necessary to improve the lives of those living with mental illness, developmental disabilities and substance abuse in the state.
In December, the Healthy Michigan Plan received approval from the Centers for Medicare and Medicaid Services.
The Healthy Michigan Plan is a strategy to reform Michigan’s Medicaid program and expand eligibility to residents through funds made available by the ACA. The plan will cover people who are not currently eligible for Medicaid, not eligible for or enrolled in Medicare and those up to 133 percent of the Federal Poverty Level-which is about $15,000 for a single person.
The state plans to make health care benefits available through the plan in early spring.
Northern Lakes Community Mental Health is a local clinic that provides Medicaid-covered mental health and intellectual/developmental disabilities and substance abuse services. Services include clubhouse psychosocial rehabilitation programs, crisis intervention services and pharmacological supports.
Greg Paffhouse, CEO of Northern Lakes Community Mental Health, said he believes the ACA will provide three critical services to mental health providers and their patients. Paffhouse said services such as the substance abuse treatment have been underfunded, and he believes the ACA will provide new opportunities for people with substance abuse disorders to also access care.
“One, I really appreciate the opportunity all persons will have to have access to health care, both physical and mental. Within the ACA, the principle of parity is also key, and I hope it will reduce the stigma which prevents people from accessing care.” Paffhouse said. “I also think the ACA will increase the integration of mental health and physical health and will also support prevention and early intervention, which is critical.”
In Michigan, community mental health programs have an “ability to pay” schedule. This allows people to access care, even if their income is limited, Paffhouse said.
However, he said CMH services are for those with more severe conditions, therefore many people with mild to moderate mental health conditions cannot access care. Paffhouse said limited non-Medicaid funding through CMH programs also limits how many people can be served, the services provided and the length of services.
“We have large worries about how much State General Fund dollars will be removed from CMH in anticipation of how many of the people we serve being enrolled in Healthy Michigan,” Paffhouse said.
Paffhouse said he is still concerned that if the legislation is not implemented well, it will lead to care being disrupted.
“The ACA is not perfect legislation, and there are many unknowns,” Paffhouse said. “It is a concern how they will access behavioral health,” Paffhouse said. “The mental health benefits under market place coverage will vary, and there remains uncertainty what the benefits will be for Healthy Michigan, including those with mild to moderate conditions.
Still, Paffhouse said it’s important lawmakers and communities continue to find ways to better engage people with mental illness, their families and community supports.