Under the health-insurance reform, effective Jan. 1, individual and small-group health plans must cover 10 essential benefits, which now include mental illness and substance use disorder services. These plans must meet health and substance use parity, as defined in the Mental Health Parity and Addiction Equity Act of 2008, meaning coverage for mental health and substance abuse services generally cannot be more restrictive than those for medical and surgical services.
Additionally, Colorado is one of 15 states that adopted Medicaid expansion, which increases eligibility coverage parameters for individuals. Now, those between the ages of 19 and 64 that have a monthly or annual income below 138 percent of the federal poverty level are eligible to receive Medicaid coverage. This translates to an individual income of $1,238 per month or $15,856 annually. A two-person household is eligible if its annual income is below $21,404.
Seven weeks into the New Year, the effect of these changes already can be seen throughout Northern Colorado.
“We have just begun to see how the ACA and parity will play out,´ said Joanna Sinnwell, North Range Behavioral Health business development director. “Although January numbers are not yet in, we know that the ACA has allowed more people in our region to receive Medicaid and third-party insurance coverage, allowing them to seek our services, which has been good for people, the community and for our business.”
North Range Behavioral Center, with 18 locations throughout Weld County, served more than 12,000 individuals seeking mental-health services in 2013.
With more people eligible for coverage, that means an influx of patients. Facility expansion and faculty increases are in the works to successfully manage higher patient loads. North Range Behavioral Center is opening a new location March 1 in Greeley.
“We knew that we would be getting people with more insurance coverage,” Sinnwell said.
Emily Petersen, development and marketing director for Touchstone Health Partners, also acknowledged making changes to keep up with the increase.
“We’ve known a patient-load increase was coming,” she said. “We have seen a trend with the increasing number of clients, both adults and children since the expansion of Medicaid. We’re doing our best to plan for the influx by improving efficiencies and access to services. We’ve been planning strategically and aggressively to meet needs of growing covered population.”
Touchstone Health Partners has eight locations in Larimer County and assisted 6,100 patients in 2013. It also has worked to expand programs such as group treatment for adults and children, as well as outreach to the homeless, or near-homeless, population.
Increased facilities, faculty and programs, however, mean higher costs. Sinnwell said many funding projects are in the works at the federal level, but that money has yet to be seen.
Colorado ranks 31st in mental-health spending, with slightly more than $88 per capita.
“We have seen Medicaid funding grow 20 percent from last year,” she said, “but the funding that flows from the state and state agencies has stayed flat or declined.”
The outlook for additional funds isn’t clear. In December, to mark the one-year anniversary of the Sandy Hook Elementary School shooting, Vice President Joe Biden announced the executive branch would invest $100 million in the nation’s mental-health system. The funds would be used to expand mental health services at community health centers and in rural America.
“We have yet to see how this will be allocated through the federal and state systems,” Sinnwell said. “Though that sounds like a significant investment, it is not nearly enough to make up for the decades of low funding in behavioral health.”
She also noted that North Range Behavioral Center and Touchstone Health Partners have teamed up to apply for additional funding from the state for crisis services and mental-health first-aid training.
While funding for mental-health organizations is at an impasse, the patient numbers are steadily increasing.
“It’s a happy surprise for people when they discover they are eligible for Medicaid,” Petersen said. “They are taking advantage of the access to services that are covered.”
The immediate effects of expanded mental-health insurance coverage may not be measureable in dollars and cents, but individual success stories already are being recorded.
“Recently, we had a mom who brought her daughter into our detox unit, which they didn’t have the means to do before the health-care reform,” Sinnwell said. “When you see that kind of relief on people’s faces, it’s a real story. There’s some real hope going on there.”
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