One of the most underappreciated impacts of the Affordable Care Act is its potential to shore up our critically underfunded public mental health system.

As states consider whether to expand their Medicaid programs under the ACA, state policymakers need to understand what a huge boon that expansion would be to their state mental health programs. By expanding Medicaid coverage to those below 133 percent of poverty level, the ACA extends new access to behavioral healthcare and medicines to many of the nation's mentally ill adults who are seriously ill, but have not been qualified as disabled under Social Security rules.

This group is generally uninsured, poor, transient but not necessarily homeless, and its members struggle to access services from overstretched state-funded mental health centers or clinics. Shrinking state and local budgets have sped the erosion of services so that in many communities, the chief access-points for any behavioral health treatment or medication for this population are jails and emergency rooms.

Many lack care for ongoing behavioral and physical health problems that could be managed successfully and cost-effectively with co-located primary and behavioral healthcare and access to prescription drugs. The Medicaid expansion, for the first time, gives state mental health officials and providers a way to afford to offer those services. The promise of coverage, in fact, provides an opportunity for mental health providers to develop and organize a rational delivery system to replace the ad-hoc, fragmented, held-together-with-spit-and-ducktape affair (I can't bring myself to call it a system) we have now in most places.

There are some good examples of clinics with co-located behavioral health and primary care services for Medicaid enrollees: Molina Health Care operates such clinics in California with evident success.

There are some great opportunities for the healthcare industry in the ACA, but the opportunity to build a rational behavioral healthcare delivery system is one I hope that states, providers, policymakers, insurers and pharma will embrace. If you build it (and people have access), they will come.


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