• December 2015
  • Vol. 16, No. 9

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Examining Behavioral Health Services Under the Affordable Care Act

State behavioral health agencies are responsible for the delivery of quality, evidence-based services for individuals with mental health and substance use disorders. Two Federal laws—the Mental Health Parity and Addiction Equity Act of 2008 and the Patient Protection and Affordable Care Act (ACA) of 2010—require insurers to provide parity of coverage for behavioral health care and extend insurance coverage to millions of individuals through expansions of Medicaid, the government subsidization of insurance purchased through Marketplace Exchanges, and other insurance reforms. A new report describes the experiences, successes, and barriers encountered by a select group of State agencies working on effective service delivery under the ACA.

While health-care reforms may have improved the funding of State behavioral health services, State agencies still face many challenges in providing services to everyone in need of behavioral health care. To provide guidance and the lessons learned from the experiences of these early-innovator States—Arizona, Kentucky, Maryland, Oklahoma, and Washington—structured interviews were conducted with agencies to collect information regarding three policy areas:

  • Implementation and adoption of evidence-based practices
  • Improvement of business practices for mental health and substance use disorder service providers
  • Integration of behavioral health services with physical health care

The overall purpose of this publication is to examine these policy issues across multiple States and to highlight areas where States need guidance and technical assistance. The States that were studied showed progress in the following areas:

  • Creating active partnerships with State Medicaid, public health, and child welfare agencies
  • Addressing infrastructure challenges as new insurance coverage brings new consumers into the behavioral health systems, including training and workforce availability
  • Making certain that evidence-based practices are an integral part of insurance benefit packages and delivery mechanisms under expanded Medicaid and integrated behavioral health and physical health-care systems
  • Implementing health information technology and other efficient business approaches
  • Demonstrating that they are providing cost-effective services with measurable outcomes
  • Ensuring that State funds and block grant dollars are not spent paying for services for which insurance is available
  • Integrating behavioral health and physical health care through working closely with the State Medicaid agency to redesign funding systems and to ensure that behavioral health is treated in the context of the entire person
  • Establishing electronic sharing of behavioral health and primary care data within the restrictive context of existing legislative limitations

Case Studies of Three Policy Areas and Early State Innovators: 2014 State Profiles, published by the Center for Mental Health Services at the Substance Abuse and Mental Health Services Administration at the U.S. Department of Health and Human Services, is available at http://store.samhsa.gov/shin/content/SMA15-4418/SMA15-4418.pdf (4 MB).

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