Even though the recent health care reform legislation substantially neglects mental health concerns, older adults with mental health conditions will benefit from it in four ways. First, they will benefit from improved coverage of physical health care, which is of considerable importance to older adults with mental and/or substance use disorders because they are highly likely to have co-occurring chronic physical disorders. Second, they will benefit from improved coverage of mental health conditions. Third, they will benefit from efforts to enhance integration of health and mental health services. Fourth, they may benefit from the opportunity to buy long-term care insurance through work.
Unfortunately, there are also certain risks that will affect all older adults, including those with mental health problems. Most notable is the funding reduction for Medicare Advantage plans, which will probably result in some loss of covered services, though there is no way of knowing yet which they will be.
(1) General health coverage improvements that will benefit older adults with mental and/or substance use disorders include:
- Improved Medicare coverage of prescription drugs
- Medicare coverage of some health promotion and illness prevention measures
- Insurance reforms for older adults with employer-based health coverage, including coverage of pre-existing conditions, community rating, and maintenance of coverage during long illnesses
- Eligibility to purchase, and to get subsidies for, health coverage through the health exchanges
(2) Improved coverage of mental health services
- Just last year new federal laws required “parity” in the coverage of mental and physical health conditions in employer-based health benefits and Medicare. The health care reform legislation carries parity forward and ends the option for employers’ not to provide behavioral health coverage.
- Improved coverage of psychiatric medications, benzodiazepines and barbiturates
(3) In addition, a number of provisions in the health care reform law establish grants programs to promote the development of models of care that integrate physical and mental health care delivery. The concept of a “medical home” is particularly important in this regard.
(4) Even though the health care reform legislation did not go far in addressing long-term care reform, it did include what is known as the CLASS provision, which will allow employers to make long-term care insurance available to employees and their families at a reasonable cost. The legislation also expands home and community-based waiver opportunities to encourage states to use Medicaid to cover in-home care that makes placement in institutions unnecessary. In addition, the legislation includes provisions to improve the quality of care in nursing homes.
Since mental and behavioral disorders are among the major reasons for placement out of the home, older adults with such disorders and their family caregivers, who are at high risk for depression and anxiety disorders, can benefit from these long-term care provisions.
Implementation and Future Improvements
Although the provisions of health care reform noted above can be helpful, whether they are or not will depend on effective implementation. Particularly important will be the development of a clinically, culturally, and generationally competent workforce that is large enough to meet the needs of elder boomers and that is prepared to address behavioral as well as physical health needs. We have a long way to go before the promise of parity and health care reform is achieved. Advocates for older adults will need to be vigilant to assure implementation. In addition, advocates need to continue to speak out that health care reform is just the beginning of addressing behavioral health and long-term care needs of an aging society.
Kimberly A. Williams is the Director of The Geriatric Mental Health Alliance (GMHA) of New York and Director of the Center for Policy, Advocacy, and Education at the Mental Health Association of NYC. Michael B. Friedman is the Honorary Chair of the GMHA. Contact them at: kwilliams@mhaofnyc.org or mbfriedman@aol.com.
This article was previously published in the American Society on Aging (ASA) Mental Health and Aging Newsletter. Reprinted with permission.
