The Affordable Care Act and Peer Support
With the Supreme Court’s decision to uphold the Affordable Care Act there has been widespread speculation on how the ruling may affect healthcare in the United States. Of particular interest to Peers for Progress is how the ACA may impact the funding and dissemination of services provided by peer supporters, such as community health workers (CHW) in health care settings. Although the implementation of the ACA will occur over many years and the full impact of this legislation are uncertain, this blog will highlight two areas that may directly impact Peer Support.
Perhaps the largest impact on peer support and CHW programs will be seen under the expansion of Medicaid and provisions related to the patient-centered medical home (PCMH). As discussed in a recent Peers for Progress blog on CHWs, many peer supporters like CHWs in the United States are serving low-income populations and have been integrated into a care team using the PCMH model. Because of ACA, individuals under 65 years of age with income below 133 percent of the federal poverty level (FPL) will be eligible for Medicaid1. The Congressional Budget Office (CBO) projected that an additional 16 million people will enroll in the Medicaid program under new eligibility rules2. Furthermore, the ACA promotes innovative and cost-effective approaches to health care delivery, many of which are set within the PCMH model. Examples like projects such as the Robert Wood Johnson Foundation’s Diabetes Initiative have demonstrated the benefits and value of peer support for self-management of chronic conditions in primary care settings. Such programs are a key component of a team approach within medical homes. This team includes the patient, patient’s family, physician, nurses, medical specialists, nutritionists, social workers, behavioral health specialists, and others to provide comprehensive care. By incorporating these teams into healthcare that include peer supporters, such programs are able to provide the 4 key functions of peer support of assistance in daily management, social and emotional support, linkages to clinical care and community resources, and ongoing support. These teams also provide the kind of care needed to manage a chronic condition like diabetes because they help fill the gaps in the 8,760 hours in a year when a patient is not in the case of his or her primary physicians. Consequently the ACA may lead to sustainable fiscal models that increase the availability of and access to peer support resources to those most needed.
The Affordable Care Act may also have a dramatic impact on the healthcare workforce, especially for community health workers. For example, in 2011, as part of ACA the Department of Health and Human Services announced a $47 million initiative. A recent blog by Peers for Progress highlighted examples of how the funding was directly impacting the work of peer supporters and community health workers.
In summary, the ACA facilitates the expansion of patient centered medical homes as well as an increased community health workforce, providing an opportunity for more Americans to benefit from the care of peer support. We will continue to closely follow ACA implementation and highlight how it impacts the availability, accessibility and evidence base for Peer Support in the US Health Care System.
1) Medicaid Eligibility available online at http://www.medicaid.gov/AffordableCareAct/Provisions/Eligibility.html
2) Updated Estimates for the Insurance Coverage Provisions of the Affordable Care Act. March 2012. Congressional Budget Office. Accessed online July 10th at http://cbo.gov/sites/default/files/cbofiles/attachments/03-13-Coverage%20Estimates.pdf