The pace has quickened as we have accelerated from planning to implementation of the Affordable Care Act (ACA). The state Affordable Insurance Marketplaces (AIMs) are being built, states are designing different approaches to Medicaid Expansion (ME), and insurance companies already have submitted their Qualified Health Plans (QHPs).
Here, we present some important factoids regarding ACA implementation. Each factoid has a recommended key action that you and I must take to help make the ACA successful. We only have one option, and that option must be resounding success.
Numbers to be Insured
Factoid: HHS estimates that up to 18 million persons will become enrolled in health insurance through the optional state MEs and 20 million through the mandatory AIMs. Of these numbers, 11 million persons will have a prior mental health or substance use condition at the time of enrollment. About 6 % of these persons will have serious mental illness and 14% will have a substance use disorder. We can enroll 7 million of these peers by next March 31.
Key Action: This is a huge, unprecedented opportunity for behavioral healthcare. We must spread the word throughout the entire behavioral health community and beyond, and we must make enrollment very easy for those with behavioral health conditions.
Enrollment and Insurance Activation
Factoid: Enrollment will begin on October 1, 2013, and health insurance coverage through the MEs and AIMs will be activated on January 1, 2014. Between now and October 1, HHS will implement a major enrollment initiative in collaboration with Enroll America (www.enrollamerica.org) and a broad range of national, not-for-profit entities that are partnering with HHS. This initiative will be undertaken between October 1, 2013, and March 31, 2014. SAMHSA is a major participant in this initiative.
Key Action: Each of us must become directly involved in enrolling uninsured persons. Details on how we can do this will be made available in the next two months.
Factoid: HHS will operate Federally-Facilitated Marketplaces and will partner in the operation of state Partnership Marketplaces for those states that have elected one of these options. All remaining states will operate their own state Marketplaces. As of this month, all QHPs developed by insurance companies for 2014 have been submitted to their respective states, and for Federally-Facilitated Marketplaces and state Partnership Marketplaces, also to HHS. Those receiving insurance coverage through an AIM will receive a federal tax subsidy if their income is below 400% of the federal poverty level (FPL), as well as reduced co-pays and deductibles if their income is below 250% FPL.
Key Action: We must find out what QHPs have been submitted for our respective states and whether their mental health and substance use benefits meet parity requirements. We also must reach across the aisle and offer to partner with these QHPs to deliver needed services including peer support.
Optional Medicaid Expansion