The ACA and mental health, substance abuse treatment

written by Lisa Stand
December 15, 2011

Last week, we re-ran an earlier blog post about how expanding Medicaid through theAffordable Care Act (ACA) is critical to ending chronic homelessness. Starting in 2014, the vast majority of vulnerable adults not already on Medicaid will have the opportunity to enroll in a health benefits plan.  We talked about what this means for individuals and their access to care, and what it means for communities, given new opportunities to access Medicaid funding.

Today, we look deeper into the crystal ball to explore what health care reform might mean for mental health and substance abuse treatment.

Behavioral health services, including treatment for substance use disorders, will be part of new Medicaid benefits. Between now and 2014 – and for a long time after – policy officials and advocates will be talking about what those benefits might look like in any given state. What kinds of services will Medicaid pay for? In what kinds of settings, for how long, and by whom? These are key questions that policymakers will gradually answer as implementation proceeds. No matter what, though, it is clear that the ACA is meant to transform behavioral health care delivery, as it transforms the rest of the health care system.

Consider, for instance, that 61 percent of people served under state substance abuse programs have no insurance. Some 87 percent of those uninsured behavioral health consumers will be eligible for Medicaid. So already we can see that Medicaid will play a much bigger role than it has in the past. Many providers of substance abuse treatment do not accept Medicaid now, and will have to decide how they are going to relate to the program in the future.

We also know that the ACA is driving – or attempting to drive – integration of behavioral and physical health care (what is often called “primary care”). Experts speak of “bi-directional” integration, meaning simply that care is client-centered rather than silo-based. So a person needing medical care and behavioral health treatment will be served in a holistic fashion, wherever they access care. There is a double bottom line here – improved access and quality for the consumer; and cost effectiveness in the programs that serve them. To make this work, Medicaid is encouraging the “medical home” concept to coordinate services for people with complex needs like severe mental illness and co-occurring substance or medical conditions.

What does all of this mean when homelessness is in the picture?

- First, it means that Medicaid is moving closer to housing solutions that are proven to be effective. Medicaid does not pay for housing, but it will offer more ways to meet people clinically where they are – for instance, in supportive housing – with more of the services they need.

- Second, communities have an important window of opportunity to make their homelessness assistance programs more effective and realign their funding priorities. Now is the time to build service networks that emphasize service integration, client-centered strategies, and financing that follows the changes in health care financing.

At the Alliance, we are excited to see communities respond to these promising changes that can really improve the lives of vulnerable people who are homeless or at-risk of homelessness. We are studying models and best practices to share in the broader advocacy community. For instance, the Alliance will host a webinar in early January that will highlight the practical aspects of integrating health care with supportive housing. (Register here.)

For a more thorough look at the ACA and behavioral health, check out these materials from the Substance Abuse and Mental Health Services Administration or check out our website.