New benefits depends on continuation of federal healthcare reform

By Mary Flynn,
California Health Report

While the heated national debate about healthcare reform continues, many health communities in California are quietly making changes to prepare for the Affordable Care Act’s implementation. Federal funding is available to help community clinics transition towards what they will resemble in 2014.

One important change that’s taking place: community clinic are moving towards becoming ‘medical homes,’ or centers of care. That means qualifying low-income patients have access to primary care, pharmacy services, or specialty care (by referral). And especially exciting to health specialists is the new availability of mental health and substance abuse services, which are being included at clinics for the first time.

“For years, we separated out those conditions as if they were somehow different from a heart condition or an ulcer or if you have diabetes,” said Leslie Tremaine, the Mental Health Director for Santa Cruz County. “But in fact, what we know is that mind and body are completely connected; “health” needs to incorporate all of those needs.”

Mental health issues affect a significant number of people. According to a 2009 report, an estimated 45 million adults suffer from sort of mental illness each year, including issues with depression or anxiety, but of that population, only approximately 38% of them receive any sort of treatment for mental illness.

In Santa Cruz, behavioral health specialists are now able to seeing patients at community clinics. “Our staff are going to those sites and integrating what we do with what you go to the doctor for,” Tremaine said.

During a check-up, the primary care doctors conducts an assessment that indicates whether a patient is suffering from a mental health issue or has a substance abuse problem. If it appears the patient has a problem, they can seek treatment inside their own clinic.

“The provider can walk down the hall to office and introduce the patient to that clinician right there,” said Lynn Harrison, a Behavioral Health Program Manager. She said it is called a ‘warm handoff,’ and when this introduction happens, it significantly increases the chance the patient will continue to seek care.

Harrison explained that the county does not have enough specialists to staff each of the four clinics full-time, but they try to do a warm handoff as much as possible.

In the past, a patient would have to request an appointment with a mental health or substance abuse specialist for a different date and place. Leslie Tremaine said that simply locating behavioral health clinicians in the same building makes a difference in whether a patient will continue to seek treatment.

“For a lot of people just getting to another place is too confusing or too hard to do, and maybe they’re embarrassed about the idea of having a mental health problem so going to see a ‘shrink’ is something they wouldn’t do,” she said, “But they’d see somebody right inside their own health provider’s office.”

Additionally, unless the person was severely mentally ill, or required psychiatric observation or medication, the cost of the care would not be covered. So those suffering from mild to moderate mental conditions, such as depression or anxiety, would be less likely to receive care.

“We can see people who would otherwise not have been seen or not have met the system of care,” Harrison said.

In the past behavioral health had been largely excluded from patient care, but for Tremaine and other mental health care workers, the future of healthcare reform appears much brighter. “What we’re excited about is that healthcare reform is based on the notion that mental health and substance abuse are part of the whole picture of health,” Tremaine said.

In January of this year, four clinics in Santa Cruz County – MediCruz North County Clinic, MediCruz South County Clinic, Salud Para La Gente, and Santa Cruz Women’s Health Center – began offering a pilot public health program, called Medicruz Advantage, that expanded Medicaid eligibility.

Medi-Cruz is the name given Santa Cruz County’s Medicaid program (while Medi-Cal is the name of California’s Medicaid program). This program, whatever the name, provides necessary health care services for low-income individuals with specific diseases such as breast cancer or HIV/AIDS.

Medi-Cruz Advantage is an expansion of Medi-Cruz where patients no longer need to have a specific condition to receive care. As long as an applicant meets the eligibility requirements – resident of the county, is a legal resident, and has an income at or below 100% of the federal poverty level – they can qualify for comprehensive care.

Leslie Goodfriend, the MediCruz Advantage Manager for Santa Cruz County Health Services Agency, said that before under MediCruz, someone with a specific medical need could apply for care from the county and potentially receive care for specific services related to their condition for a few months.

“It’s what we consider ‘band-aid’ care,” she said.

“The intention behind the medical home is that people can see a doctor, not just when they’re at death’s door or when they have an acute situation, “ she said. The medical home provides patients not only with preventative wellness care, but a primary care person to contact if they have a question or an issue, rather than crowd inside emergency rooms.

”These folks did not have that before,” she said, “and they would certainly not get mental health or substance abuse services.”

The Medicruz Advantage program is not the only one of its kind. In other counties in California, it is called the Low Income Health Program (LIHP), a pilot program between now and 2014 that gives counties an opportunity to see how healthcare reform might work for them.

Fourteen counties have been authorized their own version of the LIHP in California, while another 13 are pending. Eligibility for the program varies from one county to the next, but each is part of the Affordable Care Act’s “bridge to reform” that provides heath coverage to low-income legal residents of California.

Through the program, the federal government matches what the county spends on healthcare. “Where we [the county] paid 100% of the cost before, we’d now only pay 50% and get federal reimbursement for the cost,” Tremaine said.

“The feds have made it financially advantageous to participate in the program and that helped us bring some staff on to do this,” she said.

However, whether healthcare reform will continue, and its corresponding flow of federal funding, depends largely on what the Supreme Court decides. Tremaine said that although they will continue to work towards integrating behavioral health with clinical care, access and comprehensive coverage would be hindered by the loss of federal support.

“The whole community benefits when we all have access to health care, and that health care includes mental health and substance abuse,” she said. “Healthy people make healthy communities.”