Integrated Healthcare Means Better Healthcare

"Half the state's adults and two-thirds of adolescents with mental illness aren't getting treatment. But new research finds that the disabled and poor could get comprehensive care," according to a new California HealthCare Foundation study.  

The reason is that private insurance has historically lacked mental health coverage.  This has forced patients to seek mental health care via the public system.  In California alone, over $7.8 billion in public funds was spent on mental health care in fiscal year 2012-2013. $3.3 billion of that paid for Medi-Cal beneficiaries.

The ACA is expected to close some of the gaps in mental health services by improving access to many more people.  In California specifically, the law will expand who is eligible for Medi-Cal (coverage for poor and disabled residents), enabling them to receive comprehensive mental health services.  Additionally, individuals purchasing health insurance on Covered California will now have access to mental health care.

Healthcare Reform also encourages integration between mental health and physical health care, says Neal Adams, deputy director of the California Institute for Mental Health.  This is the practice where physicians and mental health doctors coordinate the care of their patients by keeping one another informed about all aspects of the patient's health in order to provide the most comprehensive care.  The goal is for doctors who see a patient for a physical check-up will also be aware of and screen for mental health status in order to coordinate care with a mental health specialist if necessary.

For interactive maps of mental health coverage in California compared to poverty levels, see Mapping the Gaps: Mental Health in California.

Medi-Cal Benefits Reinstated, says 9th Circuit Panel

The 9th Circuit Court of Appeals on Friday ruled that federal Medicaid program prohibits California's 2009 healthcare budget cuts.  The state law halted Medi-Cal coverage (California's Medicaid program) of adult dental, podiatry, optometry, and chiropractic care, among other services.

To understand why federal preemption carried the day, it is important to understand the balance of federal and state governance of Medicaid. Medcaid benefits are jointly funded by the federal government and individual states. While states have the autonomy to decide how to run their respective Medicaid programs, the federal government has the final word on many aspects of the program, including required benefits.  

In this case, when an association of rural healthcare clinics sued to block the budget cuts, a U.S. District Court judge agreed with California that the slashed services were optional under the federal Medicaid Act, and he granted summary judgement in favor of the state. Even the U.S. Centers for Medicare and Medicaid (CMS), the federal agency that works with states to administer Medicaid, approved the cuts as "optional services." 

A 9th Circuit panel, however, said it would not defer to the agency's approval, pointing to the federal law that "unambiguously defines" those benefits cut by California among the the healthcare that Medicaid must provide. (The case in the 9th Circuit is California Association of Rural Health Clinics vs. Douglas, 10-17574)

1.4M More Now Medi-Cal-Eligible in CA

Just one day after The California State Legislature passed the main budget bill, lawmakers passed a key piece of the ACA on Saturday, expanding Medi-Cal (CA's version of Medicaid) to 1.4 million low-income people.  

Under the ACA, the federal government will fund 100% of states' Medicaid costs until 2016 for all states who choose to expand Medicaid coverage. After 2016, according to the federal medical assistance percentages (FMAPs) in the ACA, federal assistance for state Medicaid programs will begin to phase down to 90% in 2020.  The amount of FMAP a state gets is based upon the state's relative wealth, with lower per capita income states receiving higher FMAPs.

Democrats included a provision in the legislation that allows for future lawmakers to reconsider the expansion if the federal government’s share drops below 70 percent.