Overview of the Affordable Care Act (ACA)
The Patient Protection and Affordable Care Act (ACA) was signed into law by President Barack Obama on March 23, 2010. The law aims to reform the US health care system by extending health insurance coverage to over 33 million individuals nationwide. The ACA has three primary goals at its foundation, collectively known as the Triple Aim. The Triple Aim goals are: improve patient care, improve population health, and reduce the cost of health care.
The ACA includes two primary vehicles for expansion of health care coverage. First, the law provides increased access to public health care coverage for low-income Americans through state Medicaid programs. In California, the state program is known as Medi-Cal. Medi-Cal eligibility criteria were expanded to include a wider range of adults (including parents and adults without children); for example, the qualifying income threshold was increased to 138% of the federal poverty level. As a result of Medi-Cal expansion, there are approximately 1.7 million individuals in California who are newly-eligible for Medi-Cal.
Second, the law expands access to health care coverage through insurance exchanges where individuals can purchase health insurance with income-based subsidies. In California, there is a state insurance exchange called Covered California. Insurance plans through Covered California are available for individuals with income from 139-400% of the federal poverty level.
In addition to expanding coverage, the law also establishes ten essential benefits required to be included in all health insurance plans. Importantly, mental health and substance abuse services are among the essential health benefits that must be provided in all insurance plans and at parity to the health benefits covered by the plan.
The passage of the ACA means that now, more than ever before, Americans will have access to the care they need. For the complete text of the Affordable Care Act, click here. For a comprehensive summary of the ACA published by the Kaiser Family Foundation, click here. For an ACA Tool Kit published by Insure the Uninsured Project, click here.
Principles for Successful ACA Implementation in California
The inclusion of mental health and substance abuse treatment as an essential health benefit in the ACA affirmed that behavioral health, in conjunction with physical health, is a critical component of overall health and wellness. In 2012, the California Behavioral Health Directors Association* established ten principles for health care reform. The Los Angeles County Department of Mental Health (LACDMH) believes the following principles are crucial for achievement of the ACA’s Triple Aim of better health, better care, and lower costs:
- Health equity must be integrated into all aspects of ACA implementation.
- Mental health and substance use disorder systems must be equal partners with physical health care systems.
- Recovery and resiliency-driven services that are culturally and linguistically appropriate must be the standard for covered mental health and substance use benefits available to California’s Medicaid Expansion population.
- Access to mental health and substance use disorder services for both the Medicaid Expansion population and the Covered California population should be based upon established medical/clinical necessity criteria for specialty mental health services and substance use services – e.g., Medi-Cal criteria and evidence-based American Society of Addiction Medicine (ASAM) placement criteria.
- Education, prevention and early intervention for mental health and substance use disorders must be fully integrated as part of the spectrum of reimbursable services in any benefit package provided to the Medicaid Expansion population, or individuals insured through Covered California.
- Specialty mental health and substance use disorder services provided in field, home and community-based settings must be available and reimbursable under all coverage programs and opportunities.
- Mental health and substance use benefit packages must promote high-quality, patient-centered and cost-effective care and continue to support the existing safety net.
- Safety net funding for residually uninsured populations must be preserved.
- Support for policies that address the workforce composition, development and expansion to address the needs of the Medicaid expansion and Covered California populations is critical, including pathways to employment, competencies for peer support, etc.
- Coordination of mental health, substance use and primary care is essential to ensuring quality care and realizing cost savings.
Click here to read the full health care reform principles document.
*California Behavioral Health Director’s Association (CBHDA) was formerly known as the California Mental Health Director’s Association (CMHDA). In 2014, CMHDA merged with the County Alcohol and Drug Program Administrators Association of California (CADPAAC) to form CBHDA.
LACDMH Health Care Reform Initiatives
The LACDMH vision is an anchor for health care reform system redesign. The vision is to deliver effective, efficient mental health services for individuals with varying levels of mental health need in settings preferred by LACDMH clients, through systems that are organized geographically, recognizing the importance of client satisfaction, cultural diversity, and the overall health of our community. With this vision as a guide for change, LACDMH has a number of health care reform initiatives.
Improving Access to Care
LACDMH is committed to improving access to mental health services as demonstrated by the following projects:
- Use of an electronic Service Request Tracking System (SRTS). This tracking system allows requests for service to be electronically logged and transferred to the appropriate mental health service provider, enhancing referral efficiency and streamlining communication. Click here to access the SRTS website.
- Working with health plans to develop referral mechanisms between specialty and non-specialty mental health services. Clear and uniform referrals between health plans and LACDMH will ensure that clients are referred to an appropriate level of mental health services to meet their need.
- Development of universal screening and linkage processes. By creating system-wide processes for mental health service access, clients seeking services will be provided with consistent and effective connection to service.
- Participation in two-year multi-department Medi-Cal Outreach and Enrollment Services grant awarded to Los Angeles County that targets hard-to-reach populations to establish health care benefits.
Click here to view the LACDMH policy on access to care.
Increasing Integration of Care
Integration of care for physical health, mental health, and substance abuse disorders is one key to improving overall health. LACDMH is working to increase care integration through the following projects and programs:
- Through full or close collaboration, LACDMH operates a number of projects that provide clients with integrated care. These program models include mental health and substance abuse treatment, physical health services, and – if applicable – housing services provided by an integrated treatment team.. Current projects that meet this level of integration include Integrated Mobile Health Teams, the Single Adult Model, Project 50, and the Integrated Clinic Model.
- The Department of Mental Health also runs a number of programs that provide services that are co-located with another treating provider, particularly with physical health care providers. While these projects do not yet provide full integration, they include important on-site collaboration between providers. There are currently nine collaboration models operating over 30 programs throughout the county.
- The Health Neighborhood Initiative is a community-based project that brings together health, mental health, and substance use disorder providers to establish and enhance collaborative relationships and promote the integration of whole-person care. Participating service providers are linked to an extensive network of governmental and community supports including, but not limited to: county and city agencies, educational institutions, housing services, faith-based groups, vocational supports, advocacy and non-profit organizations, prevention programs, social services, etc. These providers come together with vital input from the community to enhance the health and well-being of neighborhood residents.
Enhancing Technological Capabilities
Effective use of health information technology will support and extend care. LACDMH is working to bring new technology to treatment services through three initiatives:
- The Integrated Behavioral Health Information System, known as IBHIS, is the LACDMH electronic health record. Implementation is currently underway at LACDMH directly-operated and contracted provider sites. IBHIS affords an effective and efficient electronic system for recording client information and clinical data, as well as, claiming for services rendered.
- The Telemental Health (TMH) program uses video-teleconferencing equipment to provide mental health services to individuals with a serious mental illness (SMI) at a distance. The program allows consumers who live in medically underserved areas greater access to specialty care. In ethnically diverse Los Angeles County, TMH service delivery also allows for non-English-speaking individuals to receive mental health services in their preferred language.
- eConsult is a new initiative involving electronic consultation to primary care via web-based, HIPAA-compliant, proprietary software platform/application that is designed to enhance communication between primary care and specialists. Functioning as Psychiatric Specialty Reviewers, LACDMH’s TMH and Psychiatric Consultation staff will support the primary care providers (PCPs) empanelled by the L.A Care Health Plan in their management of patients with comorbid medical and mental health conditions. Additionally, they will assist the PCPs in directing their patients to the most appropriate level of care.
Resources for Consumers, DMH Providers, and Managed Care Plans
For more information on how to get health insurance, click here.
To find LACDMH programs and facilities in your area, enter your address, city or ZIP Code on the Service Locator page. To access the Service Locator, click here.
For Specialty Mental Health Providers
For information on how health care reform impacts DMH directly-operated and contracted providers, including information about Medi-Cal managed care plans and new non-specialty mental health services, click here.
For Managed Care Plan Providers
For information on obtaining specialty mental health services for beneficiaries, click here.
Service Request Tracking System (SRTS)
To go to the SRTS web page, click here
Questions, concerns and registration forms can be e-mailed to: SRTS@dmh.lacounty.gov