MediCal and Health Reform

On March 29, 2016, the Centers for Medicare & Medicaid Services (CMS) finalized a rule to strengthen access to mental health and substance use services for people with Medicaid or Children’s Health Insurance Program (CHIP) aligning with protections already required of health plans in the commercial market. The Mental Health Parity and Addiction Equity Act of 2008 generally requires that health insurance plans treat mental health and substance use disorder benefits on equal footing as medical and surgical benefits.

In order to support states, providers, and consumers CMS has created a mailbox so that stakeholders may send questions regarding the Medicaid and CHIP final rule for mental health parity. Technical assistance will begin this fall and continue through 2018, and questions can be submitted to the mailbox at any time.  Please submit all questions/concerns to [email protected]

NAMI parents, clients and family who feel they are not getting fair insurance treatment in terms of parity can find information at: https://www.cms.gov

Other Health Reform Facts

  • 2013 Preventive health services were added to Medicare and the donut hole reduced for the pharmacy benefit.
  • Parity laws are going into place for mental health and substance use disorders which means that all health plans will need to have a core package of services.   This is very important for families with private insurance.   Also the co-pays and deductibles must be the same as for physical healthcare.   Advocacy on the core benefit issue is important to be sure that individuals in need can get psychiatric care, medications, lab work, therapy, case management, and other recovery services.   We are currently waiting for those decisions to be made.
  • Insurance Exchange:  For those making more than 133% of federal poverty, new subsidized insurance is available including through the Central CA Alliance to cover similar services.     
  • Individual mandate:  All individuals will need to get coverage through MediCal, a subsidized plan, their employer, or through the private insurance market.   This began January 2014.   There will no longer be discrimination against those with pre-existing conditions for adults and older adults.
  • Health Insurance Premium and cost sharing subsidies are available through the exchanges.
  • No limits on coverage: January 2014.   Most plans had a life time cap of $1 million dollars.  These caps are eliminated.
  • All Health Plans must have wellness programs and preventive care.  
For more information check:
www.kaiserfamilyfoundation.org
www.accesshealth.org
www.DHCS.ca.gov
www.NAMI.org
www.CHCF.org
www.cms.gov
DHCS Working Disabled Program
A critical Work Incentive program to encourage and help people with disabilities work while having access to healthcare such as MediCal. The 250% Working Disabled Program (250% WDP) allows certain working disabled individuals to become eligible for Medi-Cal by paying low monthly premiums based on net countable income. Program enrollment is done at the local county welfare department.

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