Youth & Health Care Reform
Special thanks to The Transition Policy Consortium from the Pathways to Positive Futures Training & Technical Assistance Center for sharing this great information. Learn more about the work they do at http://www.pathwaysrtc.pdx.edu/
The Impact of Health Care Reform on Services and Supports for Young Adults with Serious Mental Health Conditions
By 2014, approximately 80% of young adults who would otherwise be uninsured will have gained health insurance under the Affordable Care Act (ACA, also known as health care reform or "Obamacare"). What does this mean for young adults with serious mental health conditions? This article answers frequently asked questions, and urges stakeholders to get involved now to influence important decisions that will determine what sorts of services and supports will be made available under the ACA.
No one knows yet exactly how health care reform will impact young people with serious mental health conditions, because many important decisions about how to implement the new law have not yet been made. What is clear is that advocacy will be necessary to ensure that the needs and priorities of young adults are addressed when these decisions are made.
Under health care reform, millions of young adults who were previously uninsured will gain access to important benefits such as psychosocial counseling and prescription drugs. However, past experience suggests that some of the services and supports that are most helpful and attractive for young adults with serious mental health conditions may not be widely available, unless policy makers make a special effort to ensure that they are. That’s why it is important that advocates and other concerned citizens understand what’s at stake and what they may be able to do to influence these important decisions. This FAQ can help you get started.
Won’t the new health care reform law bring mental health coverage to many more young adults, including those with serious mental health conditions?
- Yes, the Affordable Care Act (or ACA, also known as “health care reform” and “Obamacare”) will extend mental health coverage to millions of young adults between the ages of 19 and 29. The largest impact will be through the expansion of Medicaid to include all legal residents in low income families (up to 133% of the federal poverty level). Up to now, coverage for adults, particularly adults without children, has been much more restrictive. It is estimated that up to 7.2 million uninsured young adults will be provided with health care coverage under this expansion of Medicaid. Additionally other uninsured young adults will be covered by private insurance, either through their parents’ plans (up to age 26), or through subsidized plans they purchase through new insurance “exchanges.” As many as 6 million young adults who would otherwise be uninsured may thus become covered by private insurance plans. Finally, former foster youth who were in foster care at their 18th birthday will be eligible to receive Medicaid through age 26.
- In total, up to about 80% of all young adults who would have been uninsured without the new law may gain subsidized coverage by the time the ACA is fully implemented in 2014. Precise estimates of the number of young adults with serious mental health conditions who gain health insurance are not available, but the proportion who gain coverage may be even greater than 80%, since young people with serious mental health conditions are more likely than their peers to reside in low income households.
What sort of mental and behavioral health treatment will young adults now be able to receive under private health insurance plans?
- Young adults who stay on their parents’ private health insurance plans up to age 26 or who purchase subsidized private insurance through the “health exchanges” will receive mental and behavioral health treatments specified in those plans. Private health insurance plans almost always cover important services such as psychosocial counseling and prescription drugs. What is more, under the ACA, private insurers will be required to provide new benefits that are particularly important for young people with mental health care needs. These benefits include the elimination of annual and lifetime caps on benefits, no co-pays for routine preventative care tests, and free smoking cessation programs.
- On the other hand, private health insurance policies rarely cover some key kinds of services and supports that are of particular importance to young adults with serious mental health conditions, such as case management, crisis intervention, peer support, family support and home-based support. State policy makers are now making decisions about what benefits will be included in the plans offered on the exchanges, and they can decide to include a wider variety of benefits than private insurance policies usually cover. However, this is not likely to happen unless consumers, families and other advocates push their state policy makers to include more extensive services and supports in the plans offered through the exchanges. The sections at the end of the FAQ have suggestions about what you can do to get involved.
What sort of mental and behavioral health treatment will young adults now be able to receive under Medicaid?
- One important thing to understand is that the young adults who become eligible to enroll in Medicaid under the ACA expansion may not get the same benefits as people who are currently eligible for Medicaid. The ACA only guarantees that those who gain coverage will receive benefits that are like those received by people with average private insurance policies. As noted above, these policies rarely cover some key kinds of services and supports that are currently covered under some state Medicaid plans (e.g., peer support). These types of supports are of particular importance to young adults with serious mental health conditions. States will have the option to make these supports available to people who are newly eligible for Medicaid, but with state budgets currently so tight, it seems unlikely they will do so unless there is organized advocacy creating pressure.
- To make things even more complicated, states will have the opportunity to decide whether certain of the people who become eligible for Medicaid under the ACA should receive “standard” Medicaid rather than the more limited “expansion” form of Medicaid. In particular, states will have the opportunity to include people with serious mental illness as part of the population of people who have “special health needs.” People who are defined as having “special health needs” will be eligible for “standard” Medicaid, with its potentially wider scope of coverage.
- Once again, this shows why it is so important for young adults, their families, and other advocates to get involved with the state-level task forces and commissions that are making these decisions. Without advocacy, it is unlikely that the specific needs of young adults with mental health conditions will be addressed.
Are there other decisions that states will be making that will impact the services and supports that are available to young adults with serious mental health conditions?
- States currently provide access to some kinds of supports that are not covered by private insurance or by Medicaid. These include the kinds of supports that are most important to young people with serious mental health conditions, such as supported housing, education, and employment. It is possible that states will want to redirect some of the funds currently used to finance these supports to paying for other costs that will arise as a result of the expansion of Medicaid to cover more people.
How You Can Get Involved
- Learn more, and stay up to date. At the end of this FAQ there is a list of websites that keep current information about the ACA and what is going on at the state level.
- Identify the advocacy groups in your state or community who are involved in educating policymakers
- about the services and supports needed by those with mental health and substance abuse challenges. If they are not yet involved in advocating for the needs of young adults in the implementation of health reform, educate them about these issues. If they are already involved, join their efforts.
- Ally yourself with other organizations that work with young adults in areas such as housing, employment.
- and education, and educate them to the potential opportunities and risks in health reform.
- Find out who in your state is involved in making or recommending decisions related to health reform – Which agency staff? Which legislators? Who in the Governor’s office? Write letters, make calls, and request meetings to educate these people about the services and supports needed by young adults with mental health and substance abuse challenges and the opportunities and risks posed by health reform.
- Ask to be put on mailing lists of those influencing and making decisions related to health reform, and find out if they have websites or blogs where you can voice your opinion.
- Find out what young adults with mental health conditions are doing in other states to influence health reform implementation, borrow their good ideas, and form cross-state information resources. Find out what national organizations are focusing on this issue and what information and advocacy resources they may have available.
- As health reform implementation begins, work with state and community organizations to monitor how implementation is affecting the ability of young adults to access appropriate services and supports.
- Use this information to educate decision makers in your state.
Where You Can Get More Information
The sites below all have a lot of high quality, regularly updated information about ACA, including information about what states are doing to implement ACA:
- The National Council of State Legislatures keeps state-by-state information about strategies, timelines and action plans for implementing the Affordable Care Act. www.ncsl.org/?tabid=20231
- The “State of the States” report from the Robert Wood Johnson Foundation describes what states have been doing to implement the ACA. www.statecoverage.org/stateofthestates2011
- The Commonwealth Fund has a lot of information about health care reform, including state-specific information about ACA implementation. www.commonwealthfund.org/Innovations/View-All.aspx?topic=State+Health+Policy
- The State Reforum website has discussions and related documents about each state’s work on ACA. www.statereforum.org
- Healthcare.gov has information specifically targeted at young adults (www.healthcare.gov/foryou/youngadults), as well as a clickable map that shows the funding states have for implementing the ACA. www.healthcare.gov/center