Mental Health Matters: The Critical Role of the Affordable Care Act in Expanding Access to Behavioral Health Services

It is well known that the Affordable Care Act (ACA) has played a critical role in extending health coverage to low-income, childless adults, but the significance of the expansion to young adults with mental health conditions is not often mentioned.Nearly 1 in 5 Americans experience an episode of mental illness each year and more than 50% of Americans who experience an SUD have a co-occurring mental illness. The ACA has made great strides in expanding treatment for mental health conditions and SUDs at a time when the need has never been greater, as evidenced by the opioid epidemic in both rural and urban communities.Mental illness and addiction most often strike in young adulthood.  Prior to the ACA, single adults with mental health concerns could only receive Medicaid coverage if they filed for permanent disability or had children. For those with behavioral health conditions who found their way into the criminal justice system, the paradox was even more pronounced in that they could receive mental health treatment while incarcerated, but not when they returned to the community due to limitations in Medicaid eligibility.The ACA and the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) helped change the conversation about behavioral health. The ACA provided one of the largest expansions of behavioral health coverage in history by requiring that most individual and small employer health insurance plans, including all plans offered through the Health Insurance Marketplaces, cover mental health and SUD services. Because of the law, most health plans also must now cover preventive services, like depression screening, at no additional cost.The ACA represents a significant step forward in Medicaid coverage for low-income adults with mental illness. Mental health and SUD treatment are among the 10 Essential Health Benefits that must be covered by Medicaid and the Health Insurance Marketplaces. Additionally, more than 15 million people have enrolled in Medicaid since the law took effect in 2014. The Substance Abuse and Mental Health Services Administration (SAMHSA) predicts that Medicaid will be the largest payer of mental health services nationally by 2020 – accounting for 30% of mental health spending. The progress made over the past decade to increase awareness and change perceptions of mental health and substance use disorders and their symptoms is just beginning to solidify. The coverage expansions have created a demand for services that is driving improvements in the delivery system including new screening tools, modernized service approaches, and innovative payment models. We are at a critical point for maintaining and expanding that progress.