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.
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."
Enlisting Peers as Enrollment Helpers
When it comes to making complex decisions, it's often your friends who give you the best advice.
"People really respond best when they hear about health insurance programs from people they know and trust," said Kevin J. Malone, a Public Health Analyst in SAMHSA's Office of Policy, Planning, and Innovation. "Peer and recovery community organizations really embody a great source of trusted information for people in the community."
That's the idea behind SAMHSA's Bringing Recovery Supports to Scale Technical Assistance Center Strategy (BRSS TACS) State Peer Awards for Health Reform Education. Now in its second year, the program helps peer-run and recovery community organizations build health reform-related statewide networks. Those networks have two goals: creating and disseminating state-specific educational materials on health reform and helping peer-run and recovery community organizations prepare to provide outreach, eligibility, and enrollment assistance to people recovering from mental and/or substance use disorders.
Eight peer-run and recovery community organizations recently received subcontracts: Foundation for Recovery in Las Vegas, NV; Grassroots Empowerment Project in Madison, WI; Mental Health America of Oregon in Portland; Minnesota Recovery Connection in St. Paul; National Alliance of Methadone Advocates in the Bronx, NY; Pennsylvania Mental Health Consumers' Association in Harrisburg; the Council of Southeast Pennsylvania in Doylestown; and the Transformation Center and Massachusetts Organization for Addiction Recovery in Roxbury and Boston.
"Last year's awardees accomplished a great deal with a relatively small amount of money," said Project Officer Catherine D. Nugent, L.C.P.C., Senior Public Health Analyst in the Office of Consumer Affairs at SAMHSA's Center for Mental Health Services. "Plus," she said, "most of the 2012 awardees have leveraged the funding — and the opportunity to develop their networks — so that they are continuing their efforts in some way."
In Maryland, for example, On Our Own of Maryland developed health reform marketing materials and distributed them to peer-run wellness and recovery centers and developed training materials peers will use to train others about health reform. In Vermont, Friends of Recovery created a health reform blog aimed at peers and distributed health reform information to peer-led and recovery community groups across the state as well as state planning committees concerned with behavioral health services.
"The subcontracts won't just help people get enrolled in new health insurance options," added Ms. Nugent. "As states move forward with health reform implementation, peer-run organizations can emphasize the importance of the peer workforce and inclusion of recovery support services among essential health benefits."
Enrolling Individuals from Diverse Racial and Ethnic Populations
Enrollment in the new health insurance options available under the Affordable Care Act can seem daunting to anyone. For racial and ethnic minorities, who are more likely to be uninsured currently, there may be other challenges.
"Racial and ethnic minorities may have language barriers, so the information that's put out may be hard for them to understand," said Juliet Bui, a Public Health Analyst in SAMHSA's Office of Behavioral Health Equity. "They may have some distrust of public programs and connecting with government offices. Add a behavioral health condition on top of that," she said, "and the challenges multiply."
Making sure that racial and ethnic minorities can overcome these and other barriers and take advantage of new health insurance options is the goal of the Office of Behavioral Health Equity's Health Care Reform Community of Practice. The participants are four minority behavioral health associations: the National Asian American Pacific Islander Mental Health Association, National Leadership Council on African American Behavioral Health, National Council of Urban Indian Health, and National Latino Behavioral Health Association.
The grantees have come together in a learning marketplace to share knowledge about the challenges of reaching out to racial and ethnic minorities, plus culturally appropriate strategies for overcoming such challenges.
Each organization has surveyed its members about what has worked in the past when it comes to reaching out to their constituents or enrolling them in programs like Medicaid. These practices will be collected in an online repository by the National Network to Eliminate Disparities in Behavioral Health , a SAMHSA-funded project that offers information-sharing, training, and technical assistance to organizations dedicated to diverse communities' behavioral health needs.
The four grantees will also identify a community enrollment consultant, which will be a community-based organization that will disseminate effective practices and serve as a resource to other organizations that want to get members of their communities enrolled.
For the National Latino Behavioral Health Association, participation in the initiative has already resulted in the creation of a compendium of best outreach and enrollment practices.
One successful approach is the use of promotores de salud, bilingual community educators who have the community's trust as well as intimate knowledge of community members' lives, including their insurance status. Another effective practice is the feria de salud, or health fair. "These health fairs create a safe venue for accessing information about enrollment," said Frederick R. Sandoval, M.P.A., the association's Operations Manager. "They're familiar and welcoming."