The National Association of State Mental Health Program Directors has released a presentation examining care integrationg efforts for individuals with serious mental illnesses (SMIs) in Missouri.  The presentation outlines the state's activities under the initiative and highlights care integration and cost savings achieved as a result of those efforts.  The authors assert that Missouri serves as a model for other states to follow.

From the report:

The webinar focused on Missouri’s initiative to integrate behavioral health and primary care, including the state’s application for a health home state plan amendment under Section 2703 of the Affordable Care Act.  Dr. Joe Parks, with Missouri’s Department of Mental Health, gave an overview of the state’s health home initiative highlighting their definition of health homes, services implemented, outcomes achieved such as cost savings, and recommendations for integrating health care. 

Full report: Missouri’s Efforts to Integrate Care for Individuals with Serious Mental Illness: A Catalyst for Other States (PDF | 10.61 MB)

National Association of State Mental Health Program Directors.  (2011).  Missouri's efforts to integrate care for individuals with serious mental illness: a catalyst for other states.  Parks, J.

On July 7, 2011, the Substance Abuse and Mental Health Services Administration's Center for Behavorial Health Statistics and Quality published a report summarizing the sources of payment for mental health treatment for adults as captured by the National Survey of Drug Use and Health. Among the primary findings 34.5 percent of individuals receiving outpatient mental health services reported that most costs were covered by private insurance, while 34.7 percent of individuals receiving inpatient services reported that most costs were covered by public insurance. Additionally, 26.2 percent of individuals receiving outpatient mental health services and 18.8 percent of those receiving inpatient services reported that they or a family member were the primary source of payment. Finally, of those that paid for a portion or whose family paid for a portion of treatment, 2.3 percent of individuals receiving outpatient services contributed over $5,000, while 9.6 percent of individuals receiving inpatient services contributed over $10,000. 

From the report:

For many individuals with mental health problems, their willingness to seek and their success in receiving treatment often depend on their ability to pay, either from their own resources or through private or public insurance coverage. Appropriate treatment may be inaccessible because individuals lack any insurance coverage, or the insurance coverage they have for mental health and substance abuse conditions is inadequate. The Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 and the Affordable Care Act (ACA) of 2010 have the potential to improve access to mental health and substance abuse services. The MHPAEA is expected to improve coverage for people who have limits or caps on their benefits. The ACA is intended to provide access to insurance coverage, including benefits for mental health and substance abuse conditions, for many persons who are currently uninsured.

Substance Abuse and Mental Health Services Administration. (2011). Sources of payment for mental health treatment for adults.

On March 30, the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) released Leading Change: A Plan for SAMHSA’s Roles and Actions 2011-2014.  Developed using stakeholder input, the report outlines SAMHSA’s goals, priorities, and action steps for reducing the impact of substance abuse and mental illness.  The report explains how SAMHSA will focus its resources going forward, particularly while implementing the national health care reform law and the 2008 Mental Health Parity and Addiction Equity Act (MHPAEA).  SAMHSA’s report outlines eight strategic initiatives: prevention of substance abuse and mental illness; trauma and justice; military families; recovery support; health reform; health information technology; data, outcomes, and quality; and public awareness and support.

From the report:

Recognizing the need to balance these opportunities and challenges, SAMHSA has identified eight Strategic Initiatives to focus its limited resources on areas of urgency and opportunity. The Initiatives will enable SAMHSA to respond to national, State, Territorial, Tribal, and local trends and support implementation of the Affordable Care Act and the Mental Health Parity and Addictions Equity Act. People are at the core of SAMHSA’s mission, and these Initiatives will guide SAMHSA’s work through 2014 to help people with mental and substance use disorders and their families build strong and supportive communities, prevent costly and painful behavioral health problems, and promote better health for all Americans.

Full report: Leading Change: A Plan for SAMHSA’s Roles and Actions 2011–2014 (PDF | 1.11MB)

SAMHSA.  (2011).  Leading change: a plan for SAMHSA's roles and actions 2011-2014. 

On April 21, the Kaiser Family Foundation released a brief offering an overview of the U.S. behavioral health system, outlining the sources of behavioral health financing, and discussing the relationships between payers.  Noting that Medicaid pays for 25 percent of all behavioral health expenditures, the brief focuses on Medicaid’s role in financing behavioral health services.  The brief claims that, although service utilization has increased, both insured and uninsured individuals continue to have unmet treatment needs.  The brief notes that over 60 percent of adults with a diagnosable mental health disorder do not obtain treatment while nearly 90 percent adults with a substance use or dependence disorder did not receive specialty treatment.  The brief concludes that policymakers must consider the behavioral health financing system when determining how to reform the national health care system.

From the report:

The behavioral health care system to provide mental health and substance abuse services in the United States is financed through multiple sources. These include states and counties, the federal-state Medicaid program, the federal Medicare program, private insurance coverage, patients’ out-of-pocket expenditures, and a host of smaller public and private programs. The various funding sources form a complex patchwork of programs, each with particular eligibility rules and benefits packages. The complexity of the system challenges policymakers’ ability to undertake reform in mental health policy. This primer provides an overview of behavioral health care, reviews the sources of financing for such care, assesses the interaction between different payers, and highlights recent policy debates in mental health.

Full report:  Mental Health Financing in the United States: A Primer (PDF | 2.41 MB)

Kaiser Family Foundation.  (2011).  Mental health financing in the United States: a primer.  Garfield, R.

On April 21, the Kaiser Family Foundation released a brief examining policy options that would help Medicaid to meet the needs of individuals with mental illnesses under the national health care reform law.  Outlining issues raised at a November 2010 expert roundtable, the brief notes that the law has the chance to improve access to health services for individuals with mental illnesses.  Noting that this population has unique health and social service needs, the authors suggest that states must give special consideration to covered benefits, service delivery structure, outreach, and enrollment.  The brief notes that discussion participants highlighted the need for coordinated action between the federal and state governments as well as numerous state agencies to meet the comprehensive needs of individuals with mental illnesses.  The authors found that experts are optimistic that the law will address longstanding mental health system issues of fragmentation, quality gaps, and underfunding.

From the brief:

The Patient Protection and Affordable Care Act (ACA) aims to expand access to affordable health coverage and reduce the number of uninsured Americans. A primary pathway through which many Americans will gain access to healthcare is through the expansion of Medicaid eligibility to all individuals with incomes up to 133% of the federal poverty level ($14,484 for an individual in 2011). The newly eligible Medicaid population includes many people with mental health needs. Approximately one in six currently uninsured low-income adults (those with incomes below 133% of the federal poverty level) has a severe mental health disorder and many others have mental health service needs for less severe mental disorders. Because those with a mental health disorder are more likely to have low incomes, Medicaid will be the primary source of coverage for individuals with mental illness who gain insurance under ACA. Policymakers implementing the ACA face several crucial decisions in effectively designing benefits, service delivery, and outreach and enrollment programs to meet the needs of newly-eligible adults with mental health disorders. To explore these issues, the Kaiser Commission on Medicaid and the Uninsured and the Bazelon Center for Mental Health Law convened a roundtable of national and state policy experts on November 16, 2010. This report summarizes the key issues participants raised in the discussion.

Full Report: Medicaid Policy Options for Meeting the Needs of Adults with Mental Illness under the Affordable Care Act (PDF | 447 KB)

Kaiser Family Foundation. (2011). Medicaid policy options for meeting the needs of adults with mental illness under the Affordable Care Act.

On April 21, the Kaiser Family Foundation (KFF) released a brief offering an overview of the U.S. behavioral health system, outlining the sources of behavioral health financing, and discussing the relationships between payers.  Noting that Medicaid pays for 25 percent of all behavioral health expenditures, the brief focuses on Medicaid’s role in financing behavioral health services.  The brief claims that, although service utilization has increased, both insured and uninsured individuals continue to have unmet treatment needs.  The brief notes that over 60 percent of adults with a diagnosable mental health disorder do not obtain treatment while nearly 90 percent adults with a substance use or dependence disorder did not receive specialty treatment.  The brief concludes that policymakers must consider the behavioral health financing system when determining how to reform the national health care system.

From the report:

The behavioral health care system to provide mental health and substance abuse services in the United States is financed through multiple sources. These include states and counties, the federal-state Medicaid program, the federal Medicare program, private insurance coverage, patients’ out-of-pocket expenditures, and a host of smaller public and private programs. The various funding sources form a complex patchwork of programs, each with particular eligibility rules and benefits packages. The complexity of the system challenges policymakers’ ability to undertake reform in mental health policy. This primer provides an overview of behavioral health care, reviews the sources of financing for such care, assesses the interaction between different payers, and highlights recent policy debates in mental health.

Full Report: Mental Health Financing in the United States: A Primer (PDF | 2.4 MB)

Kaiser Family Foundation. (2011). Mental health financing in the United States: a primer. Garfield, R. L.