Public Policy

Health Care Reform

On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act (PPACA) (Pub. L. No. 111-148).

Now that this monumental law is on the books, what does it mean for children with mental health challenges and their families? See below for an overview of these provisions. Please note that not all of these policies are set to happen this year. Some have been implemented now, and others not until 2014. Also, recall that a law gives the federal government the permission to do something–it is up to the federal regulatory agencies to release rules and regulations that will actually implement these policies. So there is still much work to be done at the federal and state level to make sure that these policies below have a real impact on people’s lives. The National Federation is tracking this implementation process, and as new policies come into effect, we will make sure you know about it on our website.

Provisions in PPACA to Help Children and Families

• Starting in August, no child can be denied health coverage because s/he has a pre-existing condition. Many health plans have already begun implementing this policy.

• Starting in August, dependent children can stay on their parents’ health plan up to age 26. Many health plans have already started doing this.

• Starting in August, insurers can no longer place lifetime limits on the dollar value of coverage. And in 2014, they can no longer place annual limits on coverage either.

• Starting in 2011, the law creates a new Medicaid option for states to provide home- and community-based services and supports, which will greatly expand access to these services for adults and children on Medicaid. Up until now, Medicaid has been structured to favor institutional care over home- or community-based care. This is because the federal government, which gives states a certain amount of money for their Medicaid program, requires states to provide institutional care, and doesn’t have the same requirements for home- and community-based care. Therefore, this new option will make it more affordable for states to offer these services. It is important to note that this is a state option, meaning that states do not have to use it. If this is important to you, be sure your Medicaid Commissioner is well informed of this new option.

• Starting in 2014, the law provides refundable and advanceable premium credits to families earning 133-400% of the federal poverty level (FPL) to buy insurance through the exchanges. (The FPL is currently set at $22,050 for a family of 4, though this is likely to change by 2014. So 133-144% of the 2009 FPL for a family of 4 is between $29,326 and $88,200)

• Starting in 2014, the law extends Medicaid coverage to all foster youth below age 25.

• Starting in 2014, the law expands Medicaid to everybody under age 65 with incomes up to 133% of the federal poverty level.

• The law gives extra federal fiscal support to state Medicaid and CHIP programs, which helps states to allow more adults and children into these programs.

• The law provides funding for states to develop and implement evidence-based maternal, infant and early childhood visitation models.

• The law provides $200 million in short-term funding for school-based health centers.

• New health plans must cover, at no cost to the family, comprehensive screenings and preventative care for children using the “Bright Futures” standards (which include mental health promotion) created by the American Academy of Pediatrics.

• Families can purchase child-only insurance in the exchanges, which helps children of cared for by grandparents, children of parents whose employers don’t offer insurance, and children in mixed immigrant-status households to get coverage.