Affordable Care Act Integration
Ensure That Social Workers Are Frontline Health Providers To Effect Affordable Care Act Integration
Download the Affordable Care Act Integration Issue Brief (April 2016)
Background
Implementation of the Patient Protection and Affordable Care Act of 2010 (ACA) offers a number of unique opportunities to leverage the critical role of social workers in the American health care system. The ACA catalyzed landmark changes in how health care is conceptualized and delivered in the United States, and has promoted access to health care for millions of Americans.
The ACA reforms the health care delivery system in the United States by incentivizing integrated and coordinated models of care, such as accountable care organizations, and by promoting delivery models that reduce fragmentation in the delivery of health services. The ACA has fostered innovative delivery systems that promote person-centered care and quality improvement, and aligns these innovations with reimbursement incentives. These delivery system changes leverage the essential roles of social workers as health care professionals who focus on individuals’ and families’ psychosocial needs. Research indicates that behavioral and social conditions are important factors that affect health outcomes. Studies of psychosocial interventions and enhanced care coordination find real-world reductions in hospital readmissions, improvements in adherence to the plan of care, and better participation in medical appointments, all of which reduce overall costs to the health care system.
Access to care through public and privately funded programs has also increased significantly under the ACA due to the ACA’s individual mandate and the health insurance marketplaces. More than 20 million previously uninsured individuals have gained coverage since the ACA was implemented. Medicaid expansion has also increased health care coverage for people with lower-incomes. Medicaid expansion, which provides coverage to individuals at or below 138% of the federal poverty level, is critical to addressing the nation’s health care disparities. At the current time, 32 states including DC have expanded their Medicaid programs and expansion is under discussion in others.
Policy Solutions
Promote the inclusion of social workers as essential members of health care teams in coordinated care models, including patient-centered medical homes and health homes.
Promote the role of social workers as providers, managers, and administrators of mental and behavioral health services.
Work with Congressional delegations, state legislators and regulators, NASW chapters, and like-minded stakeholders to promote Medicaid expansion, and access to high-quality health and behavioral health services for people with low incomes.
Monitor and enforce Mental Health Parity provisions to ensure that consumers have equal access to insurance coverage for mental health and substance use disorder services.
Work with the Center for Medicare & Medicaid Innovation and the Patient Centered Outcomes Research Institute to analyze workforce patterns (including social work staffing) in pilot programs and to dedicate funds to programs that feature social workers in both care coordination and mental and behavioral health roles.