Access Uncertain in ACA's Medicaid Expansion: New Enrollees Might Miss out on Mental Health Services Covered under Traditional Medicaid Programs

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Mental health providers and advocates are growing concerned that Medicaid recipients won't be able to access psychiatrists or certain specialty mental health services even with the massive expansion of Medicaid mandated under the Affordable Care Act.

Low provider payment rates under Medicaid, coupled with financial pressures on states and the federal government, threaten to limit access to mental health treatment just as an additional 16 million Americans gain coverage through the Medicaid program, experts said.

The Affordable Care Act, which was enacted in March 2010, expands the Medicaid program to anyone below 133% of the federal poverty level, which is an annual income of about $29,000 for a family of four. States are required to begin offering coverage to this group by Jan. 1, 2014.

But the benefits offered to new enrollees do not have to be the same as the ones provided currently under state Medicaid programs. For childless adults in the new coverage population, states must offer "benchmark" or "benchmark equivalent plans," meaning that the benefits for new Medicaid enrollees must be equivalent to benefit packages offered under the Federal Health Benefits Program, by the state's employee health benefits program, or by the largest commercial HMO plan in the state.

The ACA requires that the benefits package include prescription drug coverage, mental health services, and addiction treatment services that comply with the Mental Health Parity and Addiction Equity Act. And federal regulations say that individuals with disabling mental disorders and those with mental disabilities that prevent them from performing everyday tasks cannot be required to enroll in a benchmark plan. But it's unclear exactly how all of these requirements will be implemented from state to state when the Medicaid rolls swell in 2014.

That uncertainty has raised concerns. Dr. Anita S. Everett, chairwoman of the Council on Health Systems and Finance for the American Psychiatric Association and the director of community mental health services at Johns Hopkins Bayview in Baltimore, said she worries that enrollees in the new Medicaid expansion plans will miss out on some of the supportive services that traditionally have been covered by a number of state Medicaid programs. For example, these new enrollees might not have access to programs that help people with severe mental illness enter or re-enter the workforce or find housing, she said.

While it's good news that there will be millions more people with coverage for mental health services, Dr. Everett said, it seems unlikely that most of these newly covered people will be eligible for some of the specialty services that are offered under traditional Medicaid programs.

Budget constraints at the state and federal levels also will play a role in what mental health services are available to Medicaid beneficiaries. …