Community mental-health services benefit greatly from health-care reform

Passage of health-care reform legislation was an historic event that will affect virtually all Americans in one way or another. For those of us fortunate to already have health insurance, the impact will be felt primarily in the wallet: We may need to pay a little more for our coverage.
For 31 million Americans who are presently uninsured, some of whom suffer from mental illness, the impact of health-care reform will be more dramatic. About half of those will become eligible for Medicaid benefits, while the other half will qualify for commercial insurance plans.
Since nearly half of all Medicaid beneficiaries have a psychiatric illness, it seems appropriate to mention two significant ways in which that population will be affected.
One is the removal of the disability requirement for Medicaid eligibility. All adults under age 65 who have incomes at or less than 133 percent of the federal poverty level are now eligible. In addition, effective Jan. 1, 2014, their benefit packages must include parity (equal coverage) for medical and physical health services.
The new law also provides various project grants to states, including $25 million to enable them to enroll Medicaid beneficiaries with severe and persistent mental illness into "medical homes." The medical-home concept is intended to assure complete coordination of all an individual's medical services through a treatment team. These pilot project grants become available Jan. 1, 2011.
This legislation also prohibits discrimination by group or individual health plans against those who have preexisting medical conditions, beginning Jan. 1, 2014. In the meantime, it creates a temporary high-risk insurance pool for U.S. citizens and legal immigrants who have a preexisting condition and have lacked coverage for at least six months.
There is a significant benefit for Medicare recipients in this legislation as well. Those whose prescription expenses reach the "doughnut hole" in Medicare Part D coverage ($2,700 to $6,150) in 2010 will receive a $250 rebate. During the next 10 years, the beneficiary co-insurance rate for this coverage gap will narrow in phases from the current 100 percent to 25 percent in 2020.
Another important feature of the new law is its support for the co-location of primary care and behavioral health care. The bill authorizes $50 million in grants for coordination and integration of primary-care (medical) services with mental health and substance-use treatment within the same location.
Because many people who struggle with a serious mental illness and/or a problem with alcohol or drug use also have concomitant medical issues, it can be very helpful for them to receive screening services for these conditions within the same facility.
This substantial expansion of behavioral health benefits will have a dramatic impact upon Washington state's mental health and chemical-dependency providers.
It is estimated that the state will need to recruit 564 additional mental health workers just to serve the new Medicaid-eligible individuals.
In an effort to address this need for training additional health care workers, the new law authorizes a substantial increase in funding for the National Health Service Corps. The bill provides for grants to fund behavioral health education and training.
This includes grants to universities to support recruitment and education of students in a variety of behavioral health fields. This will mean additional financial aid opportunities for the student as well, especially those working in medically underserved areas.
Whether one believes that the federal government should be a major player in ensuring the nation's health, there is much to like in this new legislation for Americans with low incomes.
Certainly in the short run, it will cost money and, thus, add to the federal deficit. The big question that remains is whether over time, the new law will pay for itself by slowing the incessant increase of health-care costs, which for several decades have expanded at a rate faster than that of general inflation.
We just need to wait and see if that happens. In the meantime, this law should have a substantial positive impact upon the health (and mental health) of those who historically have had few options for consistent medical treatment. And at least for those folks, that is very good news.

Dr. David R. Stone is chief executive officer of Sound Mental Health, King County's largest mental health-services provider.[[In-content Ad]]