Delaware Health and Social Services

NAMI Delaware Conference: January 24, 2013Rita Landgraf, Secretary, Department of Health and Social Services

ACA and Mental Health Care: Closing the Gaps

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Health Care Spending vs. Outcomes

Source: United Nations Development Programme Report 2007-2008. Retrieved from www.unnatuaralcauses.org

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ACA: Challenge and OpportunityDelawareans benefit from

health care reform by:

• Increased access to health insurance and quality health care, including mental health services.

• Being supported in community-based settings.

• Promoting healthy lifestyles.

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Need for Increased Access• More than 45 million adults had a

mental illness in 2011, according to a federal Substance Abuse and Mental Health Services Administration survey.

• About 11 million had a serious illness.

• More than 40% did not get care.

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ACA’s Effect on Providers• Primary care re-established as gateway

to medical care, including those in need of mental health services.

• Systems and reimbursements will focus on patient outcomes and measurable standards.

• Must transition from what Gov. Markell calls a “sick care system” to one that encourages positive outcomes and healthy behavior.

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ACA’s Effect on Providers• Concern about geographic

distribution of primary care providers, especially in underserved and rural areas, including Sussex.

• For each member, the MCO must have a PCP available within 30 minutes or 30 miles of residence.

• Every 2,000 patients = 1 PCP

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Data on Primary Care PhysiciansThe 2011 Primary Care Physicians in

Delaware report found:• 888 active PCPs (FTE = 707 physicians;

that’s down from 736 in 2008)• Population to provider ratio = 1,274 to 1

(up from 1,187 to 1 in 2008; capacity = 2,000)

• 86% accept new patients, but only 69%-70% accept new Medicare & Medicaid clients

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Patient-Centered Medical Homes• Transforms the organization and delivery

of primary care. 

• The practice treats the “whole” patient, including physical and mental health needs, coordinating care with specialists, hospitals, and home- and community-based care.

• Convenient hours and secure communication organized around patient.

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Health Benefit Exchange• Delaware’s HBE must go live by

Jan. 1, 2014; enrolling clients by October 2013.

• Pursuing a state-federal exchange partnership option rather than create a state exchange.

• Partnership option permits Delaware to maintain control of plan management and consumer assistance functions.   

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ACA: Medicaid Expansion• In January 2014, Delaware

will widen eligibility up to 138% of the federal poverty level ($15,415 for an individual; $31,809 for a family of four).

• State expects to cover an additional 20,000 to 30,000 Delawareans.

Federal government will pay 100% of the cost for newly eligible clients from 2014-2017; phased down to 90% of costs by 2020.

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Why Medicaid Is Important• Medicaid is the largest payer for mental

health services in the U.S.

• It accounts for 27% of all expenditures for mental health services.

• Individuals with mental health disorders represent 11% of the individuals enrolled in Medicaid.

• And they represent almost 30% of all Medicaid expenditures.

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Use of Health Care Services• Almost 12 million ER visits in

2007 involved people with a mental disorder, substance abuse problem or both.

• Almost one-fourth of hospital admissions are associated with a mental or substance abuse disorder.

• Medicaid coverage can help with access.

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Among Goals for Coverage• Be able to identify and treat mental illness and

substance abuse disorders in order to improve overall health.

• Services and programs should be person-centered and support health, recovery and resilence of individuals.

• Individuals and families should have choice.• Services should be of high quality and consistent with

clinical guidelines or evidence-based practices.• Services should maximize community integration.

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Mental Health Goals of ACA• Screen for mental and

substance abuse disorders, including those in children.

• Increase access to behavioral health services for people with serious and/or chronic disorders.

• Improve integration of primary care and behavioral health.

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Mental Health Parity Act• The 2008 act ended differences for benefits for people

dealing with mental illness or substance abuse.• Health plans could not charge higher co-pays or

deductibles for mental health services or place tighter limits on the number of therapy visits.

• Protections applied only to health plans offered by large employers.

• In 2014, ACA extends benefits to plans offered by small employers and those that individuals buy. Medicaid and CHIP will have to offer equivalent mental health benefits.

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Delaware’s Workforce Needs• Delaware’s aging population, health

care reform, and additional insured clients under Medicaid expansion and health benefit exchange will increase demands on health professionals.

• To deal with shortage: Encourage nurse practitioners to practice to top of licenses, using prescriptive authority.

• Electronic medical records: As of July, 95% of providers enrolled in the DHIN.

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Delaware’s Workforce Needs• Delaware experiencing shortages

among mental health providers, especially in Kent and Sussex.

• Use State Loan Repayment Program to attract professionals.

• Telehealth will help extend resources, especially for specialty care, including telepsychiatry. As of July 1, Medicaid now reimburses for telehealth-delivered care.

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Community-Based Services• The right care in the right place at the right

time. For mental health care, it means:• Receiving care in the most integrated and least

restrictive setting possible.• 24/7 mobile crisis and mental health screeners.• Drop-in centers and peer support services.• State Rental Assistance Program to help with

housing and increased employment opportunities.• HB311, reforming Delaware’s emergency mental

health detainment law.• HJR17, creating a study group to review the state’s

civil mental health laws.

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YOUR TURN • What is important to you relative to mental

health care, state government and the next term?

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