News Briefs

Kaiser 50-state report on the impact of the ACA on coverage: New reports for each of the 50 states from the Kaiser Family Foundation (KFF) show how the Affordable Care Act (ACA) changes insurance coverage in each state. The ACA provides new coverage options for many of the nation’s 47 million nonelderly uninsured people, but there are large differences between states based on the makeup of their low-income populations and whether a state expands the Medicaid program. Each state report provides a breakdown of how many uninsured people are eligible for Medicaid or for financial assistance to help them buy private insurance on the new exchanges. Each state report also details the income levels at which people are eligible for Medicaid or financial assistance. For states not expanding Medicaid, the reports quantify how many uninsured people with incomes below the poverty level fall into the “coverage gap” and will be ineligible for financial assistance or for Medicaid. For larger states, the reports also estimate how many uninsured residents are undocumented immigrants and are therefore ineligible for any coverage under the ACA. The state reports complement an interactive map that allows users to click on each state to obtain key data. These and other resources on health care reform and its effects are available on the KFF Web site at kff.org/health-reform.

Archived SAMHSA seminar on AOT: In December, the Substance Abuse and Mental Health Services Administration (SAMHSA) held a public seminar to facilitate a discussion on assisted outpatient treatment (AOT), also known as involuntary outpatient commitment. The purpose was to start a conversation about this approach to treatment, which has strong supporters and equally strong critics, and to present multiple perspectives. The 3.5-hour seminar, which is archived and available for viewing (www.wciconferences.com/aott/archives.html), included presentations by Marvin Swartz, M.D., and Jeffrey Swanson, PhD. They presented research findings on the effectiveness of AOT, including information about the provision of intensive treatment services, including medication treatment, case management, and psychosocial therapies. The second panel included Chacku Mathai, C.P.R.P., an individual with lived experience of mental illness, Brian Stettin, J.D., an attorney who helped craft the New York State law on AOT, and Stephanie Le Melle, M.D., a psychiatrist who works with AOT clients. Among the issues discussed by the panels were violence and mental illness, lack of insight (anosognosia), disparities and AOT, AOT’s impact on help-seeking behavior, and its fiscal impacts. The panelists raised important issues about the rights of individuals and the imperative to support safe communities. Question and answer sessions were held after each panel presentation.

SAMHSA-HRSA resources on the business case for integrated care: Many primary care organizations are integrating behavioral health care services into their settings. Effective models have emerged that include the use of care managers and behavioral health consultants. Administrators of primary care organizations are accountable to the organization’s board and staff and to the larger community, and they often must address the question of how to pay for implementing integrated care. The Center for Integrated Health Services (CIHS) has developed several resources to help administrators and advocates create the business case for integration (www.integration.samhsa.gov/financing). A central message is that most primary care organizations underestimate the positive impact that providing behavioral health services will have on their bottom line in terms of clinical productivity. In many environments, even when there is no direct reimbursement for behavioral health care, “warm hand-offs” to an appropriate team member will quickly show a return on investment. Among the CIHS tools is an eight-page monograph that describes a suggested approach for creating the business case, an Excel template to estimate the organization’s costs and revenues, and an online presentation from health centers that have made the business case, in which providers outline lessons learned. The CIHS is funded jointly by SAMHSA and HRSA and run by the National Council for Behavioral Health.

CHCS report on children’s use of behavioral health care: A 50-state analysis released by the Center for Health Care Strategies (CHCS) shows that although less than 10% of children enrolled in Medicaid use behavioral health care, this care accounts for roughly 38% of program expenses. The 100-page report, Faces of Medicaid: Examining Children's Behavioral Health Service Utilization and Expenditures, explores patterns of behavioral health service use and expense and provides insights to inform state efforts for improving care for this population. According to the report, children in foster care and those on Supplemental Security Income disability benefits represent one-third of the Medicaid child population using behavioral health care but account for more than half (56%) of total behavioral health service costs. Children using residential treatment and therapeutic group care represent under 4% of the Medicaid-enrolled children who use behavioral health services but account for 19% of total behavioral health expenses. Almost half of Medicaid-enrolled children who are prescribed psychotropic medications receive no identifiable behavioral health treatment. The findings point to several opportunities to enhance children's behavioral health, including expanding access to appropriate and effective services beyond psychotropic medications; investing in care coordination models, especially those with a wraparound approach; and enhancing collaboration between behavioral health, primary care, child welfare, and other child-serving systems. Several provisions under the ACA, including funding for health homes and increased support for home- and community-based services, may present pathways for states to pursue these improvements. The report was made possible through the Annie E. Casey Foundation, with additional support from SAMHSA and The Commonwealth Fund. The report is available on the Web site of CHCS (www.chcs.org/), a nonprofit health policy resource center dedicated to improving health care quality for low-income Americans.

NIDA releases 2013 data from Monitoring the Future Survey: Each year the National Institute on Drug Abuse (NIDA) conducts the Monitoring the Future Survey of drug use and attitudes among American eighth, tenth, and 12th graders. Data for 2013 show generally encouraging trends. However, the softening of attitudes toward some types of drug use was evident, particularly decreases in perceived harm and disapproval of marijuana use. The survey found that 39.5% of 12th graders view regular marijuana use as harmful, down from last year’s rate of 44.1% and considerably lower than rates in the past two decades. Rates of marijuana use have also changed significantly in recent years, with 6.5% of 12th graders smoking marijuana daily in 2013, compared with 6% in 2003 and 2.4% in 1993. Nearly 23% of 12th graders said they smoked marijuana in the month before the survey, and just over 36% reported use during the past year. Among tenth graders, 4% reported daily use, 18% reported past-month use, and 29.8% reported use in the previous year. More than 12% of eighth graders reported past-year use. Cigarette smoking continues to decline. For the first time, the percentage of students in all three grades combined who say they smoked cigarettes in the past month is below 10% (9.6%), compared with 16.7% ten years ago and 24.7% in 1993. Use of alcohol by teens also continues to decline. For 12th graders, alcohol use peaked in 1997, with more than half (52.7%) reporting drinking in the past month. In 2013, this rate fell to 39.2% among 12th graders. The indicator of binge drinking stayed the same as last year for eighth graders (5.1%) but dropped considerably for tenth graders (to 13.7% from 15.6% in 2012.) The 2013 binge drinking rate for 12th graders was 22.1%. These and other findings are available on the survey’s Web site (www.drugabuse.gov/related-topics/trends-statistics/monitoring-future).