Medicaid > Legislation

The Deficit Reduction Act

The Deficit Reduction Act of 2005 (Public Law 109-171) made sweeping changes to the Medicaid program.  The Bazelon has produced a summary of how those changes affect people with mental illnesses and conducted a study (2007) of how states reacted to the changes by making changes their own state Medicaid program. 
 
 

Medicaid and Health Care Reform

The Affordable Care Act, passed in 2010 under the banner of health care reform, also significantly  improved many Medicaid provisions that affect children and adults with psychiatric disorders. See additional resources on these changes:
 
 
The New Health Care Reform Act and Medicaid: New Opportunities for Psychiatric Rehabilitation, by Allison Wishon Siegwarth and Chris Koyanagi, Psychiatric Rehabilitation Journal, 2011, Vol. 34, No. 4 (available by subscription or purchase)
 
Medicaid Policy Options for Meeting the Needs of Adults with Mental Illness under the Affordable Care Act: Examines the salient issues raised in a November 2010 roundtable discussion of national and state experts convened by the Kaiser Commission on Medicaid and the Uninsured, in partnership with the Bazelon Center for Mental Health Law, to discuss Medicaid policy options available under health reform to help meet the needs of adults with mental illnesses.The Patient Protection and Affordable Care Act will expand the Medicaid program, offering the opportunity to improve access to care for millions of Americans with mental health disorders. States face several decisions about designing benefits, structuring service delivery and conducting outreach and enrollment for this population, which has unique health and social service needs. This report highlights key policy opportunities and challenges related to these decisions. The discussion was part of an ongoing series of Health Reform Roundtables that explore key issues related to implementing the expansion of Medicaid under health reform.
 
Tobacco cessation: CMS has issued a letter to state Medicaid directors providing guidance on how to implement section 4107 of the Patient Protection and Affordable Care Act (ACA), P.L. 111-148, which expands tobacco-cessation services to pregnant women and other Medicaid beneficiaries, such as individuals with mental illnesses. People with mental illnesses are twice as likely to smoke and studies suggest that reaching out to them is an effective approach to reducing the prevalence of smoking. It is also important to note that individuals with mental illnesses have a higher rate of cardiovascular mortality, a disease associated with tobacco use. Expanding tobacco cessation service will be cost-effective, as diseases associated with tobacco use are expensive and preventable. Tobacco-related diseases, such as cancer, heart disease, stroke and chronic obstructive pulmonary disease, cost $96 billion a year in medical expenses, and close to the same amount in lost productivity. Additionally, the Medicaid program would save $9.7 billion after five years if all Medicaid enrollees stopped smoking.
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