Posted on August 29, 2011 15:02
Categories: Medicaid | Special Populations | Treatment and Recovery
Topics: Access/Barriers | CHIP | Medicaid | Mental Health | Treatment
On June 30, the U.S. Government Accountability Office (GAO) released a report examining children’s access to health coverage under Medicaid and the Children’s Health Insurance Program (CHIP). The GAO studied physicians’ willingness to care for children enrolled in the programs and physicians’ willingness to accept new children insured through them. The authors also examined the difficulty physicians face in referring children enrolled in Medicaid and CHIP to specialty care. The report found that 83 percent of primary care physicians and 71 percent of specialty physicians serve children enrolled in Medicaid and CHIP. Among physicians participating in the government programs, the authors found that 79 percent are accepting new privately insured children while only 47 percent are accepting children enrolled in Medicaid or CHIP. The report also found that non-participating physicians most commonly cite administrative issues as barriers to participation, including low and delayed reimbursements. The GAO concluded that physicians face significant difficulty in referring Medicaid and CHIP-enrolled children to specialty care, including mental health.
From the report:
Most physicians are enrolled in Medicaid and CHIP and serving children covered by these programs. On the basis of its 2010 national survey of physicians, GAO estimates that more than three-quarters of primary and specialty care physicians are enrolled as Medicaid and CHIP providers and serving children in those programs. A larger share of primary care physicians (83 percent) are participating in the programs—enrolled as a provider and serving Medicaid and CHIP children—than specialty physicians (71 percent). Further, a larger share of rural primary care physicians (94 percent) are participating in the programs than urban primary care physicians (81 percent). Nationwide, physicians participating in Medicaid and CHIP are generally more willing to accept privately insured children as new patients than Medicaid and CHIP children.
Full report: Most Physicians Serve Covered Children but Have Difficulty Referring Them for Specialty Care (PDF | 1.41 MB)
Government Accountability Office. (2011). Most physicians serve covered children but have difficulty referring them for specialty care.
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Posted on August 26, 2011 15:28
Categories: Mental Health | Special Populations | Legislative and Regulatory Issues
Topics: Health Care Reform | Integrated Health | Mental Health | Spending
The National Association of State Mental Health Program Directors has released a presentation examining care integrationg efforts for individuals with serious mental illnesses (SMIs) in Missouri. The presentation outlines the state's activities under the initiative and highlights care integration and cost savings achieved as a result of those efforts. The authors assert that Missouri serves as a model for other states to follow.
From the report:
The webinar focused on Missouri’s initiative to integrate behavioral
health and primary care, including the state’s application for a health
home state plan amendment under Section 2703 of the Affordable Care
Act. Dr. Joe Parks, with Missouri’s Department of Mental Health, gave
an overview of the state’s health home initiative highlighting their
definition of health homes, services implemented, outcomes achieved
such as cost savings, and recommendations for integrating health care.
Full report: Missouri’s Efforts to Integrate Care for Individuals with Serious Mental Illness: A Catalyst for Other States (PDF | 10.61 MB)
National Association of State Mental Health Program Directors. (2011). Missouri's efforts to integrate care for individuals with serious mental illness: a catalyst for other states. Parks, J.
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Posted on July 18, 2011 21:22
Categories: Medicaid | Medicare | Mental Health | Employer and Individual Insurance
Topics: CHIP | Employer-Sponsored Coverage | Individual Coverage | Medicaid | Medicare | Mental Health | Out-of-Pocket | Spending
On July 7, 2011, the Substance Abuse and Mental Health Services Administration's Center for Behavorial Health Statistics and Quality published a report summarizing the sources of payment for mental health treatment for adults as captured by the National Survey of Drug Use and Health. Among the primary findings 34.5 percent of individuals receiving outpatient mental health services reported that most costs were covered by private insurance, while 34.7 percent of individuals receiving inpatient services reported that most costs were covered by public insurance. Additionally, 26.2 percent of individuals receiving outpatient mental health services and 18.8 percent of those receiving inpatient services reported that they or a family member were the primary source of payment. Finally, of those that paid for a portion or whose family paid for a portion of treatment, 2.3 percent of individuals receiving outpatient services contributed over $5,000, while 9.6 percent of individuals receiving inpatient services contributed over $10,000.
From the report:
For many individuals with mental health problems, their willingness to seek and their success in receiving treatment often depend on their ability to pay, either from their own resources or through private or public insurance coverage. Appropriate treatment may be inaccessible because individuals lack any insurance coverage, or the insurance coverage they have for mental health and substance abuse conditions is inadequate. The Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 and the Affordable Care Act (ACA) of 2010 have the potential to improve access to mental health and substance abuse services. The MHPAEA is expected to improve coverage for people who have limits or caps on their benefits. The ACA is intended to provide access to insurance coverage, including benefits for mental health and substance abuse conditions, for many persons who are currently uninsured.
Full Report:
Sources of Payment for Mental Health Treatment for Adults (PDF | 448 kb)
Substance Abuse and Mental Health Services Administration. (2011). Sources of payment for mental health treatment for adults.
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Posted on May 23, 2011 17:57
Categories: Substance Abuse | Mental Health
Topics: Health Care Reform | Mental Health | Substance Abuse
On March 30, the U.S.
Substance Abuse and Mental Health Services Administration (SAMHSA) released
Leading
Change: A Plan for SAMHSA’s Roles and Actions 2011-2014. Developed
using stakeholder input, the report outlines SAMHSA’s goals, priorities, and
action steps for reducing the impact of substance abuse and mental
illness. The report explains how SAMHSA will
focus its resources going forward, particularly while implementing the national
health care reform law and the 2008 Mental Health Parity and Addiction
Equity Act (MHPAEA). SAMHSA’s report outlines eight strategic
initiatives: prevention of substance abuse and mental illness; trauma and
justice; military families; recovery support; health reform; health information
technology; data, outcomes, and quality; and public awareness and support.
From the report:
Recognizing the need to balance
these opportunities and challenges, SAMHSA has identified eight Strategic
Initiatives to focus its limited resources on areas of urgency and opportunity.
The Initiatives will enable SAMHSA to respond to national, State, Territorial, Tribal,
and local trends and support implementation of the Affordable Care Act and the
Mental Health Parity and Addictions Equity Act. People are at the core of
SAMHSA’s mission, and these Initiatives will guide SAMHSA’s work through 2014
to help people with mental and substance use disorders and their families build
strong and supportive communities, prevent costly and painful behavioral health
problems, and promote better health for all Americans.
Full report: Leading Change: A Plan for SAMHSA’s Roles and Actions 2011–2014 (PDF | 1.11MB)
SAMHSA. (2011). Leading change: a plan for SAMHSA's roles and actions 2011-2014.
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Posted on May 20, 2011 13:28
Categories: Mental Health
Topics: Medicaid | Mental Health | Treatment
On
April 21, the Kaiser Family Foundation
released a brief offering
an overview of the U.S. behavioral health system, outlining the sources of
behavioral health financing, and discussing the relationships between
payers. Noting that Medicaid pays for 25
percent of all behavioral health expenditures, the brief focuses on Medicaid’s
role in financing behavioral health services.
The brief claims that, although service utilization has increased, both
insured and uninsured individuals continue to have unmet treatment needs. The brief notes that over 60 percent of
adults with a diagnosable mental health disorder do not obtain treatment while
nearly 90 percent adults with a substance use or dependence disorder did not
receive specialty treatment. The brief
concludes that policymakers must consider the behavioral health financing
system when determining how to reform the national health care system.
From the report:
The behavioral health care system to provide mental
health and substance abuse services in the United States is financed through
multiple sources. These include states and counties, the federal-state Medicaid
program, the federal Medicare program, private insurance coverage, patients’
out-of-pocket expenditures, and a host of smaller public and private programs.
The various funding sources form a complex patchwork of programs, each with
particular eligibility rules and benefits packages. The complexity of the
system challenges policymakers’ ability to undertake reform in mental health
policy. This primer provides an overview of behavioral health care, reviews the
sources of financing for such care, assesses the interaction between different payers,
and highlights recent policy debates in mental health.
Full report: Mental Health Financing in the United States: A Primer (PDF | 2.41 MB)
Kaiser Family Foundation. (2011). Mental health financing in the United States: a primer. Garfield, R.
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Posted on May 20, 2011 13:19
Categories: State and Local | Special Populations
Topics: Health Care Reform | Mental Health
On April 21, the Kaiser Family Foundation published a brief outlining policy options for addressing the needs of individuals with mental illnesses through Medicaid under the national health care reform law. Noting that the law will result in a large expansion of Medicaid coverage, the authors assert that states have important decisions regarding benefits, service delivery, outreach, and enrollment in order to meet the needs of individuals with mental illnesses. The authors outline proposals to ensure that the meets of this population are addressed as states expand their Medicaid programs.
From the report:
The Patient
Protection and Affordable Care Act (ACA) aims to expand access to affordable
health coverage and reduce the number of uninsured Americans. A primary pathway
through which many Americans
will gain access to healthcare is through the expansion of Medicaid eligibility
to all individuals with incomes up to 133% of the federal poverty level
($14,484 for an individual in 2011). The newly eligible Medicaid population
includes many people with mental health needs. Approximately one in six currently
uninsured low-income adults (those with incomes below 133% of the federal
poverty level) has a severe mental health disorder and many others have mental
health service needs for less severe mental disorders. Because those with a mental health disorder are more likely to have
low incomes, Medicaid
will be the primary source of coverage for individuals with mental illness who
gain insurance under ACA. Policymakers
implementing the ACA face several crucial decisions in effectively designing benefits,
service delivery, and outreach and enrollment programs to meet the needs of
newly-eligible adults with mental health disorders.
Full report: Medicaid Policy Options for Meeting the Needs of Adults with Mental Illness Under the Affordable Care Act (PDF | 446.79 KB)
Kaiser Family Foundation. (2011). Medicaid policy options for meeting the needs of adults with mental illness under the Affordable Care Act.
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