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Federal reform would bolster mental health care but challenges remain

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Federal health reform will increase mental health coverage in myriad ways, but state law still leaves longstanding challenges in place, a panel of federal government authorities and mental health advocates told members of the California Legislature yesterday.

No member of the panel could pinpoint how many people would gain access to treatment for depression, psychiatric disorders or substance abuse. But authorities emphasized that such treatment was being seamlessly sewn into the fabric of expanded care.

"Mental health is not singled out as much as it's integrated," Donald Moulds, a top policy official with the federal Health and Human Services Agency told lawmakers. "It is more a matter of looking at a system that serves all of these conditions."

A report issued yesterday by the UCLA Center for Health Policy Research said health reform will expand coverage eligibility to two-thirds of California's uninsured, about 4.9 million out of 7 million.

Moulds and other panelists summarized various ways the health reform law will expand mental health and substance abuse coverage:

  • Mental health and substance abuse care will be considered “essential benefits” that insurance plans offered by state health insurance exchanges offer. The exchanges, a key part of the health reform law, would essentially provide a big tent for people who are currently not covered or are covered by individual plans. The exchange taking shape in California is expected to wield negotiating clout, seeking the best coverage at the best price for consumers.
  • Under health reform, adults who are poor and have no children will be covered by Medi-Cal in California. According to a briefing prepared by the Senate Office of Research, many members of this group are expected to benefit from mental health and substance abuse treatment.
  • The concept of mental health coverage “parity” is baked into the cake of health reform. That means insurers will be expected to provide mental health coverage that is on par with physical health coverage.

The health reform law also includes a wide array of grants and pilot projects aimed at improved mental health screening and treatment.

Health providers in Alameda, Glenn, Los Angeles and San Mateo counties have already qualified to take part [PDF] in a program to bring together mental health and day-to-day medical care.

Sandra Naylor Goodwin, president of the California Institute for Mental Health, said during the briefing that such an approach is proven to save money. Goodwin referenced several studies and projects that brought mental health and primary care together, with clear potential to save millions of dollars.

She also noted that it’s a worthy goal, too, referencing research that says people with severe mental illness tend to live 25 fewer years than the general population. Often, she said, lives are shortened because of treatable and preventable medical conditions.

“This is a serious problem that we need to address,” she said.

However, she said a California law stands in the way of saving that money: Medi-Cal does not pay clinics for giving mental health care and medical services on the same day.

The prohibition is a roadblock to giving patients access to a diabetes check-up minutes after a visit with a psychiatrist to manage medications.

State senators Darrell Steinberg, D-Sacramento, and Wesley Chesbro, D-Arcata, have carried laws to change this.

One such bill died last year and Gov. Arnold Schwarzenegger vetoed a 2007 measure, noting that allowing billing for medical and mental health care on the same day “could increase general fund pressure.”



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