The Affordable Care Act: improved options for North Carolinians with mental illnesses.

The Affordable Care Act, the health reform law enacted in 2010, offers new options to improve the quality of and access to mental health care for North Carolinians. This commentary will discuss provisions of the law that have the potential to enhance the lives of individuals with mental illnesses.

The new health care reform act and medicaid: new opportunities for psychiatric rehabilitation.

TOPIC: This article examines significant new opportunities presented by the Affordable Care Act, the health care reform law passed in the spring of 2010, and specifically addresses changes to the Medicaid program that may be of great benefit to individuals with severe psychiatric disabilities, as well as their relevance to the field of psychiatric rehabilitation. PURPOSE: The authors offer an assessment of the myriad new options created by health reform, with particular emphasis on those that improve and expand services for persons with severe psychiatric disabilities in their homes and communities. Selective information is presented on the expansion of specific state options within Medicaid that, if implemented, may prove most useful for those with serious psychiatric disabilities. SOURCES USED: Material was drawn from relevant federal statutes and published literature, as well as personal observation. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: While the health care reform law creates many new opportunities for states to fund and provide services for persons with disabilities, the complexity of the law may present implementation challenges for state authorities, providers, advocates, and consumers alike. Those interested in learning more about the options presented in this paper and further implications of health care reform are encouraged to explore additional resources and information.

Can we learn from history? Mental health in health care reform, revisited.

Health reform is again on the national agenda. Serious debate about how mental health might fit into national health policy has not occurred since 1993. The focus of the Clinton reformers was on benefits, integration with the general health system, and a new role for the public sector. A number of issues remain relevant today, such as uncoordinated public and private services, cost-shifting, and poor quality care for people with serious mental illness. This column considers the barriers to full inclusion of mental health in health care reform and proposed solutions that were identified in 1993 and describes how they can inform policy decisions in 2009.

The Deficit Reduction Act: should we love it or hate it?

Some new options created for state Medicaid programs under Title VI of the Deficit Reduction Act (DRA) could have grave consequences for people with mental illness. Some provisions allow states to limit coverage, increase copayments, impose new premiums, and cap benefits. More positive DRA provisions would make it easier for states to provide home- and community-based services. A ten-state demonstration program will expand coverage for children. The author concludes that a state's adoption of the DRA's mental health-friendly provisions may not offset the damage done by its other provisions.

Medicaid policies to contain psychiatric drug costs.

This study reviews Medicaid policies to restrict access to psychiatric medications. Policies on prior authorization, preferred drug lists, limitations on the number of prescriptions, fail-first requirements, and use of generics are reviewed. All states apply one or more of those policies to medications for mental illness, and many apply several. A large number of states have legislated exemptions from those policies for certain medications, particularly antipsychotics and antidepressants. Other psychiatric medications are less well protected. Some states appear to restrict access severely. Questions have been raised as to whether these policies actually save money in the long term.

The TEFRA medicaid eligibility option for children with severe disabilities: a national study.

The Tax Equity and Fiscal Responsibility Act (TEFRA) Medicaid Eligibility Option, also known as the Katie Beckett Option, was developed to allow children with disabilities from near-poor and middle-income families to qualify for Medicaid. TEFRA has been available since 1982; however, little is known about the number of children served and their qualifying disability. This first national study found that 20 states enrolled nearly 25,000 children in 2001. Only 10 of these states allowed children to qualify because of a mental health disability. Additional research is needed to understand the role of TEFRA in providing insurance to children with disabilities.

Behavioral health screening policies in Medicaid programs nationwide.

Under the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) mandate, states are required to screen Medicaid-insured children for mental health and substance use disorders. This national study found that states vary considerably in their policies. Nearly half the states (23 in total) have not addressed behavioral health issues in their EPSDT screening tools at all. More states have screening tools that address mental health than substance use disorders. Most states have created their own screening tools, which suggests discomfort with or a lack of awareness of the standard tools available. Screening policy options to increase behavioral health screening rates are discussed.