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Strategy Brief: Getting Involved In Your State

The Affordable Care Act presents an opportunity for advocacy by state advocates to improve access to insurance benefits and behavioral health services that are needed and have long been denied many Americans.
MHA encourages its affiliates and community partners to engage with state, federal and private sector decision makers to ensure that ACA is implemented robustly and the behavioral health provisions contained in the law improve the lives of individuals living with mental health and substance use conditions.

In order to realize the true potential of the new health reform law and ensure that the modern behavioral health system is developed in an appropriate way to serve the needs of individuals with mental illnesses, state and local advocates must monitor and be engaged in the implementation process. Different states will utilize different strategies for implementing the law and determining the ways the Medicaid expansion and health insurance exchange will be put into operation. Below are a few tips for engaging in process in your state so behavioral health is adequately represented in the process:

Identify, join or create coalitions of voluntary health organizations and provider organizations from various conditions in order to advocate for the views of mental health and substance use consumers and providers. This process can actually be of assistance to your state implementation team as it provides a demonstration of stakeholder participation.

  • Contact state advocacy groups who you believe may be organizing around health reform to determine how you might become involved. If a coalition has already been formed, ask to be involved to offer your expertise on mental health and substance use issues.
  • If a coalition has not been formed, hold a meeting and invite partners from the behavioral health field, as well as partners from other voluntary health organizations to organize advocacy efforts around health reform.
  • As an organization or coalition, advocate for the development of a committee or advisory group through statute or executive order on which mental health and substance use advocacy groups sit to inform the health establishment of the Exchanges. See the sample letter and statute as a template.

Advocate for benefit plans that will be developed for the expanded Medicaid population to include robust mental health and substance abuse services.

  • This will require meeting with your state Medicaid Director and Mental Health Commissioner to discuss the requirements of managed care companies who are seeking contracts for the Medicaid benchmark or standard plans. Relationships with your managed care organizations should be developed as well. They can become your ally.
  • Advocate for appropriate outreach processes to identify and enroll individuals in traditional or managed Medicaid

Advocate for robust mental health and substance abuse services as essential benefits for the Exchanges, as these will be the basis for the essential benefits in the Medicaid expansion plans.

  • Meet with government officials to advocate for a robust mental health and substance use benefit in the Exchange. Provide key legislators, the Insurance Commissioner, Health Commissioner, Medicaid Director, and/or Mental Health Commissioner a list of essential benefits that must be included in the essential benefits package. Refer to MHA's Exchanges Fact Sheet for a sample list.
  • Monitor federal guidance regarding the essential benefits package. If the federal essential benefits package regulations are not as robust as your coalition has advocated for, advocate for the enhanced benefits in your state.

Offer consultant services to the state insurance commissioner, health department, Medicaid director, mental health and substance use authority, and governor's office to provide feedback and advice regarding the interests of the behavioral health community. Various services that may be needed are:

  • Your state implementation team may introduce conforming legislation to insure that your state statutes are consistent with the ACA. Become involved and supportive of this process, irrespective of its relevance to specific behavioral health issues. Use this as an opportunity for MHA to become, and be seen, as a leader in Health Care Reform implementation in your state.
  • Advocate for a robust essential benefits package to be adopted by the state for the Exchanges and Medicaid expansion;
  • Advocate for adequate Request for Proposal language to solicit bids for managed care organizations to provide robust behavioral health services in Medicaid benchmark plans;
  • Advocate for adequate Request for Proposal language to solicit bids for insurance providers applying to operate within the Exchanges to provide robust behavioral health services; and
  • Provide guidance on methods of engagement of consumers with mental health and substance use conditions for enrollment in Medicaid and the Exchange.

Other roles of behavioral health advocates and their coalitions:

  • Utilize MHA's Health Reform Talking Points and Op-Ed to bring awareness to the great potential the appropriate implementation of health reform has for individuals with mental health and substance use conditions, their families, providers, and communities.
  • Monitor federal funding coming to the state as a result of the Affordable Care Act. Advocate for the appropriate use of funds for establishment of the exchanges, prevention programs, Medicaid expansion, workforce development, etc.
  • Advocate for appropriate use of health information technology to implement seamless integration between the Exchange and Medicaid populations, being aware of the need for behavioral health information to be included, and consumers' rights and confidentiality be maintained. For more information, please see MHA's Issue Brief on HIT.

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