Affordable Care Act (ACA) in the District of Columbia Department of Behavioral Health

1. Affordable Care Act (ACA) in the District of Columbia Department of Behavioral Health Steve Baron, Director Steve.baron@dc.gov April 26,1014 Department of Behavioral Health

2. Creation of the Department of Behavioral Health • In October 2013 the Department of Behavioral Health (DBH) was established by the merger of the Department of Mental Health (DMH) and the Addiction Prevention Recovery Administration (APRA) which formerly was in the Department of Health.

3. Why the New Department of Behavioral Health? • In FY 12, about 23,000 residents received mental health services through the Department of Mental Health and about 7,500 obtained substance abuse services through APRA. • It is estimated 30-50% have both mental health and substance use disorders. • Effectively serving individuals with mental health and substance use disorders means early detection and integrated services that are individualized and responsive. • The new Department of Behavioral Health has as its goal that all providers will be co-occurring competent meaning they will able to assess, diagnosis and if needed refer for services as well as developing a number of providers that are co-occurring enhanced, able to provide the full range of mental health and substance use disorder services.

4. Benefits of Integrated Care • Integrated treatment leads to lower costs and better outcomes: • Reduced substance use • Improved psychiatric symptoms and functioning • Decreased hospitalization • Increased housing stability (homelessness) • Fewer arrests • Improved quality of life

5. Affordable Care Act (ACA) in DC • The District was an early participant in the ACA. • Beginning in July 2010 DC began enrolling childless adults into the Medicaid based on the threshold of 133% of poverty. • Many of these individuals individuals were on the District Health Alliance program that is supported by 100% local funds (as opposed to Medicaid’s 70% federal funds and 30% local) and which did not have a mental health or substance abuse benefit

6. Medicaid enrollment • Individuals who are enrolled in Medicaid due to the changing eligibility criteria are assigned to a Medicaid Managed Care Organization (MCO) • There are four Medicaid MCOs and they are responsible for providing and paying for the full range of office based services • DMH pays for out of office services which are predominately Community Support, Assertive Community Treatment (ACT) and Community Based Intervention (CBI)

7. Impact of ACA on DBH • The percentage of Medicaid covered individuals receiving services through the DBH network has increased from about 70% in 2010 to 93% of the over 22,000 individuals seen in a year. • Beginning in January 2014 for individuals who have enrolled since the passage of the ACA in July 2010through the new ACA criteria there is a much lower state match which starts at 0%. • ACA offers other opportunities such as Health Home initiative

8. Health Insurance Exchanges • The ACA requires 10 essential services including mental health and substance abuse services to be offered by health plans • Individuals accessing health insurance coverage through the exchanges are receiving coverage through commercial insurance plans such as Care First, Kaiser • Many of these plans should include licensed professional counselors as part of their provider networks

9. Opportunities in DC for Licensed Professional Counselors • Seek employment with a provider within the DBH network • Enter into a contractual relationship with one of the MCOs • Receive CEUs through the DBH Training Institute

10. How to Get Help Call 24/7 Access Helpline: 1-888-793-4357 1-888-7WE-HELP) for mental health services and supports Call Emergency Mobile Crisis Services: (202) 673-9300 • Call (202) 727-8473 for substance use disorders services and supports: Visit a community based provider: www.dbh.dc.gov