These slides are from a lecture describing some of the main provisions of the Patient Protection and Affordable Care Act (P.L. 111-148) also known as the ACA or "Obamacare". Medicaid expansion and the health insurance exchanges are considered. Information on the status of ACA implementation is also presented.
These slides are from on lecture on the role of psychotropic drugs in mental health treatment. Topics covered include the pharmaceutical industry, direct-to-consumer advertising, the CATIE and STAR*D studies, Medicare Part-D, and the role or pharmacy benefit managers.
Mental Health Policy - Mental Illness and the Criminal Justice SystemDr. James Swartz
These slides are from a lecture on the criminal justice system and mental illness and considers factors related to the criminalization of those with mental illnesses, characteristics of those with mental illness under criminal justice supervision, and the role of drug and mental health courts.
These slides are from on lecture on the role of psychotropic drugs in mental health treatment. Topics covered include the pharmaceutical industry, direct-to-consumer advertising, the CATIE and STAR*D studies, Medicare Part-D, and the role or pharmacy benefit managers.
Mental Health Policy - Mental Illness and the Criminal Justice SystemDr. James Swartz
These slides are from a lecture on the criminal justice system and mental illness and considers factors related to the criminalization of those with mental illnesses, characteristics of those with mental illness under criminal justice supervision, and the role of drug and mental health courts.
Addiction Medicine: Closing the Gap between Science and PracticeCenter on Addiction
These slides accompany CASAColumbia's report, Addiction Medicine: Closing the Gap between Science and Practice, published in June 2012, which found that, despite the prevalence of addiction, the enormity of its consequences, the availability of effective solutions and the evidence that addiction is a disease, both screening and early intervention for risky substance use are rare, and only about 1 in 10 people with addiction involving alcohol or drugs other than nicotine receive any form of treatment.
Selected Psychological and Social Factors Contributing to Relapse among Relap...inventionjournals
Drug abuse is a major global problem and in Kenya there has been increasing drug and alcohol abuse with serious negative effects. Treatment and rehabilitation of alcoholism is expensive and non-conclusive due to consequent relapse. This study sought to find out selected psychological and social factors contributing to relapse among recovering alcoholics of Asumbi and Jorgs Ark rehabilitation centres in Kenya. This study adopted the descriptive survey design. The population of the study comprised of all relapsed alcoholics and rehabilitation counsellors in Asumbi and Jorgs Ark rehabilitation centres in Kenya. A sample of 67 recovering alcoholics and 13 counsellors was drawn from the two purposively selected rehabilitation centres and used in the study. The study used two sets of questionnaires, one for relapsed alcoholics and another for rehabilitation counsellors. The questionnaires were piloted to validate and establish its reliability before the actual data collection. Data was collected through administration of two sets of questionnaires to the selected respondents. The data was then processed and analyzed using descriptive statistics including frequencies and percentages with the aid of Statistical Package for Social Sciences (SPSS) version 20.0 for windows. The key findings of this study indicated that the selected psychological factor that mostly contributed to relapse was dwelling on resentment that causes anger and frustration due to unresolved conflict. The social factor that mostly contributed to relapse was hanging around old drinking friends. The key conclusion was that in view of selected factors dwelling on resentment that causes anger and frustration due to unresolved conflict was the major contributor to relapse. The research findings may benefit NACADA, Ministry of Public Health, mental health agencies, psychologists, counsellors, Non-Governmental organizations, policy makers, researchers, drug abusers and alcoholics in Kenya to better understand factors contributing to relapse and devise ways and means of reducing relapse. Based on the major findings of this study, it is recommended that all stakeholders undertake measures aimed at providing a solution to continued relapse of alcoholics by improvement of rehabilitation and follow-up programmes.
Barbados 2012-13 Health Accounts ReportHFG Project
This report presents the findings and policy implications of Barbados’ first Health Accounts estimation, conducted for the year April 2012 to March 2013. It captures spending from all sources: the government, non-governmental organizations, external donors, private employers, private insurance companies and households. The analysis presented breaks down spending to the standard classifications, as defined by the System of Health Accounts 2011 framework, namely sources of financing, financing schemes, type of provider, type of activity and disease/health condition.
Addiction Medicine: Closing the Gap between Science and PracticeCenter on Addiction
These slides accompany CASAColumbia's report, Addiction Medicine: Closing the Gap between Science and Practice, published in June 2012, which found that, despite the prevalence of addiction, the enormity of its consequences, the availability of effective solutions and the evidence that addiction is a disease, both screening and early intervention for risky substance use are rare, and only about 1 in 10 people with addiction involving alcohol or drugs other than nicotine receive any form of treatment.
Selected Psychological and Social Factors Contributing to Relapse among Relap...inventionjournals
Drug abuse is a major global problem and in Kenya there has been increasing drug and alcohol abuse with serious negative effects. Treatment and rehabilitation of alcoholism is expensive and non-conclusive due to consequent relapse. This study sought to find out selected psychological and social factors contributing to relapse among recovering alcoholics of Asumbi and Jorgs Ark rehabilitation centres in Kenya. This study adopted the descriptive survey design. The population of the study comprised of all relapsed alcoholics and rehabilitation counsellors in Asumbi and Jorgs Ark rehabilitation centres in Kenya. A sample of 67 recovering alcoholics and 13 counsellors was drawn from the two purposively selected rehabilitation centres and used in the study. The study used two sets of questionnaires, one for relapsed alcoholics and another for rehabilitation counsellors. The questionnaires were piloted to validate and establish its reliability before the actual data collection. Data was collected through administration of two sets of questionnaires to the selected respondents. The data was then processed and analyzed using descriptive statistics including frequencies and percentages with the aid of Statistical Package for Social Sciences (SPSS) version 20.0 for windows. The key findings of this study indicated that the selected psychological factor that mostly contributed to relapse was dwelling on resentment that causes anger and frustration due to unresolved conflict. The social factor that mostly contributed to relapse was hanging around old drinking friends. The key conclusion was that in view of selected factors dwelling on resentment that causes anger and frustration due to unresolved conflict was the major contributor to relapse. The research findings may benefit NACADA, Ministry of Public Health, mental health agencies, psychologists, counsellors, Non-Governmental organizations, policy makers, researchers, drug abusers and alcoholics in Kenya to better understand factors contributing to relapse and devise ways and means of reducing relapse. Based on the major findings of this study, it is recommended that all stakeholders undertake measures aimed at providing a solution to continued relapse of alcoholics by improvement of rehabilitation and follow-up programmes.
Barbados 2012-13 Health Accounts ReportHFG Project
This report presents the findings and policy implications of Barbados’ first Health Accounts estimation, conducted for the year April 2012 to March 2013. It captures spending from all sources: the government, non-governmental organizations, external donors, private employers, private insurance companies and households. The analysis presented breaks down spending to the standard classifications, as defined by the System of Health Accounts 2011 framework, namely sources of financing, financing schemes, type of provider, type of activity and disease/health condition.
Respond by Day 5 to at least two colleagues in one of the follmickietanger
Respond by Day 5
to at least two colleagues in one of the following ways:
Describe two factors that might make minority groups especially vulnerable in the Medicaid policy your colleague cited. Explain why these groups may not have a voice in the policy-making process.
Offer examples of organized self-help and citizens’ groups as both support mechanisms and potentially powerful lobbies. Describe how these lobbying bodies can help in amending the policy your colleague described.
Colleague 1
Chana Smith
RE: Discussion - Week 9
COLLAPSE
How the evolution of health care policy has influenced programs such as Medicaid and Medicare.
America health policy shifted from environmental concerns to individual. Over time we have moved from dispensaries, to marine hospitals, to focusing on check ups. "The federal government entered briefly into health provision during Franklin Roosevelt's New Deal with the Resettlement Administration's medical cooperatives" (Popple & Leighninger, 2019). The Depression led way for prepaid programs such as, Blue Cross and Blue Shield, due to hospitals being left with unpaid hospital bills. The government stepped back in when those who were less healthy, retired, unemployed, underemployed or self employed suffered. This is when both the Democratic and Republican parties worked together to put forth proposals that would protect the senior population that was getting left out of the employer based health plans (Popple & Leighninger 2019). Hospitals were reimbursed by Medicare however, continuously rising hospital costs, resulted in the Reagan administration developing a standardized payment based on diagnosis. Medicare became their cash cow because congress was able to take advantage of the cost reduction by transferring savings in Medicare into the general deficit reduction (Popple & Leighninger, 2019).
Specific Medicaid policy in your state that should be amended, and explain how you would amend it and why.
The Medicaid policy in North Carolina that should be amended is the policy that prohibits payment for diet programs in weight loss centers. Helping recipients with their goal towards weight loss could help reduce Medicaid costs. Medicaid paying for weight loss programs could result in lowered expenses towards weight related health issues such as high blood pressure, and diabeties (dhhs.gov, 2018).
The stakeholders involved in the Medicaid and Medicare health care policy in your state, and explain the role of these stakeholders in policy development for this issue.
The stakeholders involved in the Medicaid and Medicare health care policy include ombudsmen, providers, and consumer health advocacy groups. The provide expertise and knowledge to contribute towards identifying solutions to meet the needs the people. They then work together towards developing the policy (Nguyen, & Miller, 2018).
Colleague 2
Tameka Sutton
RE: Discussion - Week 9
COLLAPSE
In this week’s discussion, we are to communicate the devel ...
Health Care Reform and Harm Reduction: Laura Hanen, Rachel McLean - HRC 2010Harm Reduction Coalition
A presentation by Laura Hanen (NASTAD) and Rachel McLean (California Department of Public Health) on what health care reform means for harm reduction and drug user health. Presented at the Harm Reduction Coalition's 8th National Conference, November 18-21, 2010 in Austin, Texas.
Harvard's Robert Greenwald on Texas MedicaidOneVoiceTexas
Robert Greenwald, JD, Clinical Professor of Law and Director of Center for Health Law and Policy Innovation at Harvard Law School, presented an in-depth analysis forum of the federal health reform Affordable Care Act and associated transformation of the Texas Medicaid system. On January 24 in Austin, he spoke to sever audiences on the challenges and opportunities specific to Texas including why the Affordable Care Act’s Medicaid expansion is so important to the provision of cost- effective, high quality care and treatment to low income uninsured Texans.
Professor Greenwald has over 20 years of experience in the fields of health law and policy. His Center is recognized as a national leader in Affordable Care Act implementation and in efforts to improve healthcare access and health outcomes for the uninsured and underinsured.
One Voice Texas and the Harris County Healthcare Alliance sponsored the event.
Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
ICH Guidelines for Pharmacovigilance.pdfNEHA GUPTA
The "ICH Guidelines for Pharmacovigilance" PDF provides a comprehensive overview of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guidelines related to pharmacovigilance. These guidelines aim to ensure that drugs are safe and effective for patients by monitoring and assessing adverse effects, ensuring proper reporting systems, and improving risk management practices. The document is essential for professionals in the pharmaceutical industry, regulatory authorities, and healthcare providers, offering detailed procedures and standards for pharmacovigilance activities to enhance drug safety and protect public health.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
Mental Health Policy - The Affordablle Care Act and Mental Health
1. Mental Health Policy II
The Affordable Care Act
Building an Effective Community Support System
10/28/2015 Jane Addams College of Social Work - Mental Health Policy II 1
2. Patient Protection and Affordable Care Act (P.L. 111-148)
Mental Health Policy II
The Affordable Care Act
• Requires most U.S. citizens and legal residents to have health insurance or
impose a phased-in tax penalty (2014 – $95; 2016 - $695 - $2,085) .
• Creates state-based health benefit exchanges through which individuals cane
purchase coverage.
• Cost-sharing credits available to individuals/families with income between 133-
400% of the federal poverty level ($15,860 for individual, $21,400 for couple).
• Separate exchanges created for small businesses (SHOP).
• Require employers to pay penalties for employees who receive tax credits through
the exchanges (to discourage this).
• Impose new regulations on health plans in the Exchanges and in the individual
and small business markets.
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3. 3
Medicaid Expansion under ACA
Mental Health Policy II
The Affordable Care Act
• Expand Medicaid to all non-Medicare eligible individuals under 65
(children, pregnant women, parents, and adults without dependent
children) with modified gross adjusted incomes up to 133% FPL
(sometimes 138% FPL because of a 5% “forgiveness”).
• Guarantee a benchmark benefit package (Alternative Benefit Plans or
APBs) that is equivalent to health benefits available on the Exchange.
• All ABPs must include the same ten “essential health benefit” (EHB)
categories established by the ACA that Marketplace health plans must
include.
10/28/2015 Jane Addams College of Social Work - Mental Health Policy II
4. 4
Medicaid Expansion – Parity Provisions
Mental Health Policy II
The Affordable Care Act
• ABPs must provide parity between physical health and mental health.
• Insurers are prohibited from capping annual and lifetime spending for
mental health and addictions treatment at levels below the caps imposed
for physical health treatment.
• Mental health and addictions services will be required as essential
benefits in the state exchanges.
10/28/2015 Jane Addams College of Social Work - Mental Health Policy II
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Medicaid Expansion under ACA
Mental Health Policy II
The Affordable Care Act
• Approximately 60% of individuals with disabilities who are dually eligible
for Medicare and Medicaid have a mental illness.
• These individuals face elevated barriers to integrated care because they
must navigate two complicated insurance systems.
• The ACA addresses this issue with the establishment of a new office
within the HHS that has integration of these two benefit programs as its
focus.
• Formally established in December 2010, the Federal Coordinated Health
Care Office will monitor progress and provide technical assistance to
states, health plans, and physicians to develop more integrated programs
of care.
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Medicaid Expansion under ACA
Mental Health Policy II
The Affordable Care Act
• The ACA expands an existing SAMHSA program, allocating an additional
$50 million in grants for coordinated and integrated services through the
co-location of primary and specialty care in existing community-based
behavioral health settings.
• These demonstration projects will generate valuable information
regarding best practices for primary care colocation that can be used by
practitioners who are working to integrate systems in years to come.
• In 2013 and 2014, Medicaid payments for fee-for-service and managed
care for primary care were increased to the Medicare reimbursement
levels, which represents a mean increase of approximately 33% across
the states
10/28/2015 Jane Addams College of Social Work - Mental Health Policy II
7. 7
Medicaid Expansion under ACA
Mental Health Policy II
The Affordable Care Act
• Federal gov’t pays 100% of the expansion (for newly qualified
beneficiaries) through 2016 and then phases down to 90% by 2020 and
beyond.
• Increase Medicaid payments in fee-for-service and managed care for
primary care services provided by primary care doctors (family medicine,
general internal medicine or pediatric medicine) to 100% of the Medicare
payment rates for 2013 and 2014.
• States will receive 100% federal financing for the increased payment
rates.
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Mental Health Policy II
The Affordable Care Act
A June 28, 2012 Supreme Court decision (National Federation of Independent
Business (NFIB) v. Sebelius) made Medicaid expansion optional for states.
.
10/28/2015 Jane Addams College of Social Work - Mental Health Policy II
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Mental Health Policy II
The Affordable Care Act
10/28/2015 Jane Addams College of Social Work - Mental Health Policy II
SOURCE: “Status of State Action on the Medicaid Expansion Decision,” KFF State Health Facts, updated September 1, 2015.
http://kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/
WY
WI*
WV
WA
VA
VT
UT
TX
TN
SD
SC
RI
PA*
OR
OK
OH
ND
NC
NY
NM
NJ
NH*
NV
NE
MT**
MO
MS
MN
MI*
MA
MD
ME
LA
KYKS
IA*
IN*IL
ID
HI
GA
FL
DC
DE
CT
CO
CA
AR*AZ
AK
AL
Adopted (31 States including DC)
Adoption Under Discussion (1 State)
10. 10
Mental Health Policy II
The Affordable Care Act
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Mental Health Policy II
The Affordable Care Act
Current Medicaid Expansion Enrollment in Illinois (August 2015):
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Mental Health Policy II
The Affordable Care Act
Current Medicaid Expansion Enrollment in Illinois (August 2015):
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Mental Health Policy II
The Affordable Care Act
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Navigators, In-Person Counselors, Certified Application
Agents
Mental Health Policy II
The Affordable Care Act
• A Community Partner is any organization or agency that assists or
supports Illinoisans in need in accessing supportive benefits. Community
Partners in ABE include organizations certified as Illinois Navigators, In-
Person Counselors and Certified Application Agents.
• Community partners can help individuals complete their own application
or make computers available for individuals to complete their own
applications.
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Health Homes under ACA
Mental Health Policy II
The Affordable Care Act
• Health homes for people with chronic conditions. The ACA provides
states with a new option (described in section 2703) to reform the delivery
system for beneficiaries with chronic conditions by providing “health
home” services and authorizes a temporary 90% federal match rate for
these services.
• To qualify for health home funding states must develop a model that is
focused on beneficiaries with at least two chronic conditions; one
condition and at risk of developing another; or at least one serious and
persistent mental health condition.
• Health home providers will integrate and coordinate all primary, acute,
behavioral health and long term services and supports to treat the “whole-
person” across the lifespan.
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Health Homes under ACA
Mental Health Policy II
The Affordable Care Act
States have flexibility to determine eligible health home providers. Health
home providers can be:
• A designated provider: May be a physician, clinical/group practice, rural
health clinic, community health center, community mental health center,
home health agency, pediatrician, OB/GYN, or other provider.
• A team of health professionals: May include physicians, nurse care
coordinators, nutritionists, social workers, behavioral health professionals,
and can be free-standing, virtual, hospital-based, or a community mental
health center.
• A health team: Must include medical specialists, nurses, pharmacists,
nutritionists, dieticians, social workers, behavioral health providers,
chiropractics, licensed complementary and alternative practitioners.
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Mental Health Policy II
The Affordable Care Act
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Health Insurance Exchanges
Mental Health Policy II
The Affordable Care Act
• The ACA calls for the creation of state-based American Health Benefit
Exchanges and Small Business Health Options Program (SHOP)
Exchanges, administered by a governmental agency or non-profit
organization, through which individuals and small businesses with up to
100 employees can purchase qualified coverage.
• Permit states to allow businesses with more than 100 employees to
purchase coverage in the SHOP Exchange beginning in 2017.
• Restrict access to coverage through the Exchanges to U.S. citizens and
legal immigrants who are not incarcerated.
• Enrollment (for most individuals) is restricted to open-enrollment periods
(Nov. 15 2014 – Feb. 15, 2015).
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Mental Health Policy II
The Affordable Care Act
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Health Insurance Exchanges
Mental Health Policy II
The Affordable Care Act
• Marketplace enrollment is currently open only for individuals who have
gone through a qualifying life event - such as a marriage, job change,
birth of a baby, or other change. Those who qualify are eligible for a
Special Enrollment Period, or SEP. The SEP lasts for 60 days in the
Marketplace after the marriage or other life event. The SHOP Marketplace
and Medicaid are open for enrollment year round.
• Illinois enrolled 349,487 through the Illinois Health Insurance Marketplace
(GetCoveredIllinois) through February 2015.
• Insurers submit plans to the Illinois Department of Insurance to be
considered for inclusion in the Marketplace.
10/28/2015 Jane Addams College of Social Work - Mental Health Policy II
21. 21
Health Insurance Exchanges
Mental Health Policy II
The Affordable Care Act
Creates four benefit categories of plans plus a separate catastrophic plan to
be offered through the Exchange, and in the individual and small group
markets:
• Bronze plan represents minimum creditable coverage and provides the
essential health benefits, cover 60% of the benefit costs of the plan, with
an out-of-pocket limit equal to the Health Savings Account (HSA) current
law limit ($5,950 for individuals and $11,900 for families in 2010);
• Silver plan provides the essential health benefits, covers 70% of the
benefit costs of the plan, with the HSA out-of-pocket limits;
10/28/2015 Jane Addams College of Social Work - Mental Health Policy II
22. 22
Health Insurance Exchanges
Mental Health Policy II
The Affordable Care Act
• Gold plan provides the essential health benefits, covers 80% of the
benefit costs of the plan, with the HSA out-of-pocket limits;
• Platinum plan provides the essential health benefits, covers 90% of the
benefit costs of the plan, with the HSA out-of-pocket limits;
• Catastrophic plan available to those up to age 30 or to those who are
exempt from the mandate to purchase coverage and provides
catastrophic coverage only with the coverage level set at the HSA current
law levels except that prevention benefits and coverage for three primary
care visits would be exempt from the deductible. This plan is only
available in the individual market.
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23. 23
The Illinois Health Insurance Exchange
Mental Health Policy II
The Affordable Care Act
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24. 24
Essential Benefits
Mental Health Policy II
The Affordable Care Act
By law, every qualified health plan (QHP) on the Marketplace must include:
• Outpatient services, like services or tests done at a medical center or doctor’s
office that do not require you to stay overnight.
• Emergency services, like medical care given to treat a sudden or unexpected
illness in an emergency to keep you from getting worse.
• Hospitalization, like services, tests or surgery that require you to stay the night in
the hospital.
• Maternity and newborn care, like services during pregnancy and after your baby is
delivered, including breastfeeding.
• Mental health and substance use disorder services, including behavioral
health treatment, like services that improve your mental well-being or treat a
mental illness or substance use problem.
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Essential Benefits
Mental Health Policy II
The Affordable Care Act
• Prescription drugs
• Habilitative and Rehabilitative services and devices, like physical therapy, which
helps you recover skills that you lost because you were hurt or disabled, or helps
you develop and maintain the skills you need.
• Laboratory services
• Preventative and wellness services and chronic disease management like check-
ups and screenings to help you stay healthy, and services to improve your quality
of life by preventing or lowering the effect of a disease. This includes monitoring
and educating you about your treatment.
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Essential Benefits
Mental Health Policy II
The Affordable Care Act
• Pediatric care, including medical, dental and vision care for children.
• Dental coverage available through the Marketplace at an additional cost.
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The ACA and Immigrants
Mental Health Policy II
The Affordable Care Act
Undocumented immigrants (139,000 in Illinois?):
• Unable to buy private health insurance in exchange and ineligible for
federal financial help.
• Exempt from individual mandate.
• Remain ineligible for Medicaid.
• Can purchase private insurance.
• Can get emergency healthcare and at FQHC community agencies.
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Federally Qualified Healthcare Centers
Mental Health Policy II
The Affordable Care Act
• Healthcare center is an all-encompassing term for federally qualified
healthcare centers (FQHCs) and FQHC look-alikes; they are a key
component of the health care safety net that provided care to more than
20 million Americans in 2011.
• Health centers (FQHCs and FQHC look-alikes), provide comprehensive
primary health, oral health, mental health/substance abuse services, and
enabling services. Health center is an all-encompassing term for a diverse
range of public and nonprofit organizations and programs that provide
primary care services.
• Those that receive federal grant funding are known as Section 330
grantees, which include FQHCs. FQHC look-alikes meet the same
requirements as FQHCs but do not receive federal grant funding.
10/28/2015 Jane Addams College of Social Work - Mental Health Policy II
29. 29
Federally Qualified Healthcare Centers
Mental Health Policy II
The Affordable Care Act
The Federal Health Center Program supports four types of health centers:
Federally qualified health centers—Section 330 (e), which serve a variety of
medically underserved populations and areas.
Migrant health centers –Section 330 (g), which provide care to migrant and
seasonal agricultural workers and their families in a culturally sensitive way.
Health care for the homeless programs–Section 330 (h), which reach out to
homeless individuals and families to provide primary care, substance abuse, and
mental health services.
Public housing primary care programs—Section 330 (i), which are located in
public housing communities and serve their residents.
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Federally Qualified Healthcare Centers
Mental Health Policy II
The Affordable Care Act
• Health centers, supported by the Health Resources and Services
Administration (HRSA), treated approximately 21.7 million people in
2013, sixty‐two percent of whom are members of ethnic and minority
groups. Thirty‐five percent have no health insurance; thirty‐two percent
are children.
• By definition, FQHCs must provide care in medically underserved areas
and to medically underserved populations (MUA/MUP).
10/28/2015 Jane Addams College of Social Work - Mental Health Policy II
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Federally Qualified Healthcare Centers
Mental Health Policy II
The Affordable Care Act
• The ACA has positioned health centers to play a crucial role in the future
health care environment by establishing the Community Health Center
Fund that provides $11 billion over a 5 year period for the operation,
expansion, and construction of health centers throughout the Nation. $9.5
billion is targeted to:
• Support ongoing health center operations.
• Create new health center sites in medically underserved areas.
• Expand preventive and primary health care services, including oral
health, behavioral health, pharmacy, and/or enabling services, at
existing health center sites.
• $1.5 billion will support major construction and renovation projects at
community health centers nationwide.
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Federally Qualified Healthcare Centers
Mental Health Policy II
The Affordable Care Act
• Health centers are required by law to provide services to all people,
regardless of ability to pay. The uninsured are charged for services on
a board-approved sliding-fee scale, which is based on a patient’s
family income and size.
• Health centers are financed through a mix of Medicaid and Medicare
reimbursements (with different payment methodologies), direct patient
revenue, other third-party payers (private insurers), state funding,
local funding, philanthropic organizations, and grant funding from the
Bureau of Primary Health Care (BPHC) of HRSA of the U.S.
Department of Health and Human Services (HHS).
• The single largest source of funding is Medicaid.
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33. 33
Federally Qualified Healthcare Centers
Mental Health Policy II
The Affordable Care Act
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34. 34
Federally Qualified Healthcare Centers
Mental Health Policy II
The Affordable Care Act
10/28/2015 Jane Addams College of Social Work - Mental Health Policy II
35. 35
Further detail:
Mental Health Policy II
The Affordable Care Act
10/28/2015 Jane Addams College of Social Work - Mental Health Policy II
Roadmap of the ACA in Illinois for people with mental health
issues: https://www.youtube.com/watch?v=SjLfnOf7j8o
Illinois Health Matters (source for Illinois policy on health
reform including ACA and FQHC):
http://illinoishealthmatters.org/
Reading on Chicago Mental Health and Public Health is posted
on Blackboard.