Implementation of the 2010 Patient Protection and Affordable Care Act is bringing big changes to the nation’s Medicaid system. In many states, the changes include a) moving Medicaid funded behavioral health to managed care, b) expanding Medicaid’s roles by 25%, and c) reforming Medicaid’s rate-setting and payment methods.
Will these changes improve recoveries for Medicaid beneficiaries diagnosed with schizophrenia? Using New Jersey as a case study, PsychOdyssey’s Tom Pyle addressed this critical question in a detailed presentation at the recent 2014 Recovery Workforce Summit conference of the Psychiatric Rehabiliation Association in a workshop entitled “Will the ACA’s Medicaid Changes Improve Outcomes for Schizophrenia? A New Jersey Case Study”.
Medicaid’s 3 big changes in New Jersey, as in many other states, are reform, expansion, and managed care. Citing 25 references, Tom’s presentation considered five change domains by which to classify and evaluate elements of these 3 big changes relevant to psychiatric rehabilitation: access, availability, quality, cost, and innovation. It reviewed the requirements of care for schizophrenia, parameters of recovery from schizophrenia, outcomes and measures of progress with schizophrenia, and the Medicaid system today that funds treatments of schizophrenia. It examined the elements of three major Medicaid changes as they relate to three subgroups of New Jerseyans diagnosed with schizophrenia: those already enrolled in Medicaid, those to be enrolled under the ACA, and those who will still remain unenrolled even though eligible to be enrolled.
Of particular note are financial challenges specific to New Jersey. Recently downgraded by the bond rating agencies, The Garden State’s bond rating is now the second lowest of all the states, suggesting the fiscal challenges that it now faces. At the same time, New Jersey, a very high cost state, also has the lowest average Medicaid rates in the country, resulting in the highest percentage of doctors (60%) not accepting new Medicaid beneficiaries, which is twice the average percentage of doctors refusing new Medicaid patients in the rest of the country.
Access to health insurance will be achieved by Medicaid’s expansion. But with Medicaid roles under the ACA projected to expand by 25%, with very few new doctors who will accomodate them, availability of doctors to care for those on Medicaid with schizophrenia, will be sorely crimped. Quality, cost, and innovation will likely also suffer. The challenges ahead for New Jersey’s Medicaid-funded public mental health care system are enormous.
For ease of presentation, Tom’s long slide presentation is divided here into two parts. Part 1 introduces the basic challenges and explains how Medicaid works. Part 2 analyzes the effects of the changes on those in New Jersey with psychiatric disabilities. Download both parts of the presentation below:
Will the ACA’s Medicaid Changes Improve Outcomes for Schizophrenia? A New Jersey Case Study
Note: PsychOdyssey wishes to express its gratitude to the Psychiatric Rehabilitation Association for the opportunity to offer this presentation at its 2o14 Recovery Workforce Summit.