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Summer 2013, Volume 21, Number 3

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Providing Education on New Health Care Options

Mark your calendar for October 1, 2013. That's when Americans can start enrolling in the new health insurance marketplaces and expanded Medicaid program created by the Affordable Care Act.

SAMHSA is making sure people know when they may soon be eligible for coverage and how to enroll. SAMHSA's new Enrollment Coalitions Initiative will ensure that behavioral health organizations are prepared to help enroll individuals in the new health insurance options and make the most of marketing materials developed by the Centers for Medicare and Medicaid Services (CMS). Other initiatives (see More Content below) focus on helping peer-run and recovery community organizations and minority behavioral health organizations do the same with their own constituencies.

New Options

The Affordable Care Act represents the largest expansion of health care coverage since Medicare's creation almost half a century ago.

"The Affordable Care Act has opened up various ways for people to get access to insurance," said Suzanne C. Fields, M.S.W., L.I.C.S.W., SAMHSA's Senior Advisor to the Administrator for Health Care Financing. "That's good news for the 49 million Americans currently uninsured," said Ms. Fields. "It's even better news for the 30 percent who have mental or substance use disorders," she added.

Starting on January 1, 2014, most Americans must buy health insurance coverage or pay a penalty. At that time, individuals, families, and small businesses will have access to a range of health benefit plans from a new health insurance marketplace—a kind of virtual shopping mall where people can shop for affordable coverage. While all plans will cover certain essential benefits, plans will offer four levels of coverage, each with different benefits, copayments, and deductibles.

States can set up their own state health insurance marketplace, work in partnership with the federal government, or have the federal government operate a marketplace on their behalf. In addition, states can opt to expand eligibility in their Medicaid programs to citizens who earn less than 133 percent of the poverty level.

"These new options will help bring coverage to many who have never had it before," said Ms. Fields. "SAMHSA estimates that six percent of individuals covered through the marketplaces and seven percent of the Medicaid expansion population will have serious mental illnesses," she said. An estimated 14 percent of both populations will have substance use disorders.

"Of course, people can only benefit if they actually sign up for the new options. SAMHSA is very concerned that people with behavioral health conditions may not necessarily know they can get insurance or know how to get insured," she said, adding that some behavioral health conditions can make it more challenging for people to figure out what option is best for them and how to enroll.

"Some may be daunted by the new choices available," said Ms. Fields. "Many people are still confused about whether they will have access to insurance or not," she said. "It's different state by state."

"Fortunately," said Ms. Fields, "CMS has developed a single, user-friendly application form consumers can use to apply for both the marketplaces or Medicaid. The law also supports 'navigators,' individuals and organizations that will provide unbiased information and help consumers review their options and get enrolled."

How SAMHSA Is Helping

SAMHSA is helping, too. The SAMHSA Enrollment Coalitions Initiative, for example, has brought together approximately 35 organizations into five coalitions representing different constituencies:

  • Consumer, Family, Peer, and Recovery Community Organizations Coalition
  • Mental Health and Substance Abuse Treatment Providers Coalition
  • Criminal Justice Organizations Coalition
  • Housing Support and Homeless Services Organizations Coalition
  • Community-Based Prevention Organizations Coalition

The initiative's goals are two-fold: to create awareness of and interest in the new health insurance options and to disseminate CMS enrollment materials through members and affiliates who interact with uninsured individuals with behavioral health conditions.

"This is our big push to get everyone ready for open enrollment," said Kevin J. Malone, a Public Health Analyst in SAMHSA's Office of Policy, Planning, and Innovation. "We're bridging the gap between CMS and intermediaries that have contact with people with behavioral health needs."

SAMHSA has brought together coalition members to discuss CMS's marketing materials and their members' training needs. In the next phase, SAMHSA will distribute toolkits coalitions can use to explain how to use the CMS materials and get members excited about doing so.

Each coalition will receive a toolkit customized for its needs. The toolkit for the prevention coalition, for example, will include information on how enrolling people will give them access to preventive services and thus help fulfill the organizations' objectives. The toolkit for the provider coalition will include a section suggesting that intake procedures include asking questions about coverage and sharing information about enrollment.

While that initial toolkit will focus on basic health insurance literacy, a second will focus on enrollment specifics.

"The best way to describe it is energetic stakeholder engagement," said Mr. Malone. "We want to get stakeholders actively involved in communication efforts so they take ownership and partner with us."

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