The federal government is reaching out to behavioral health counselors and therapist to educate them on how the Affordable Care Act works so they can encourage members of the LGBT community to enroll in an ACA health plans. Sometimes the professionals who provide important health services through health plans offered through Healthcare.gov and CoveredCa.com can be the least knowledgeable on how health insurance operates.
Supporting counselors with education
SAMHSA, Substance Abuse and Mental Health Services Administration, has produced several resources to educate behavioral health providers who serve the LGBT community. A toolkit of resources guides health professionals in helping lesbian, gay, bisexual and transgender (LGBT) people understand health insurance options, particularly mental health and substance abuse benefits and services, under the Affordable Care Act (ACA) and enroll in plans. Assistance with LGBT enrollment is important because –
- Among the LGBT community members who are low-or middle-income, one in four-26 percent-lack health insurance.
- Many of these uninsured LGBT individuals are eligible for financial assistance to gain coverage under the Affordable Care Act.
- Insurance coverage and access to health care are especially important for LGBT individuals because the LGBT population experiences health disparities such as elevated risk of depression, suicidal ideation, and substance use and misuse.
- These disparities are related to the discrimination, prejudice, and social exclusion that many LGBT people encounter throughout their life.
Source: Affordable Care Act Enrollment Assistance for the LGBT Community, SAMHSA presentation
Coverage benefits in specific to LGBT community
All health plans include essential benefits that help to maintain mental health.
- No cost preventive services for adult depression screenings and child behavioral assessments
- All Medicaid plans cover behavioral health options such as counseling, therapy, medication management, peer support and substance abuse treatment.
Guarantee issue regardless of sexual orientation
Another aspect of the Affordable Care Act that gets lost in all the marketing hype is that all plans, on and off the federal or state exchanges, are guarantee issue. In other words, pre-existing conditions can’t be considered and health insurance can’t be denied on the basis of current health challenges. However, many states do allow health plans to exempt from coverage for six months coverage for any pre-existing conditions IF the consumer didn’t have health insurance in the previous 63 days.
Plans cannot deny coverage because of pre-existing conditions such as depression, a substance use disorder, or a transgender-related medical history, and they cannot place annual or lifetime dollar limits on coverage.
Health insurance is a foreign language
For members of the lesbian, gay, bi-sexual and transgender community, obtaining individual health insurance may never have been an option for them. Shopping, comparing plans and understanding the benefits and coverage of health insurance is like learning foreign language. Consequently, it is important to have a trusted advisor such as behavioral health provider deliver clear and simple explanations of the ACA and their rights as consumers. Of course, before a provider can talk intelligently about the new ACA plans they have to understand them.
Behavioral health provider resources
The SAMHSA toolkit, the different pieces can be downloaded at the end of the post, include-
- A small briefing guide for behavioral health professionals structured around the LGBT community.
- Slide presentation to share with other office staff and professionals.
- LGBT ACA brochure on how to enroll.
- Anthem Blue Cross ACA Rules Nondescrimination Mpdf (31 KiB)
- Anthem Blue Cross Nondiscrimination Sheet Ext FAQ Final 7 25 16 (0.1 MiB)
- Blue Shield Gender Reassignment Medical Policy (0.7 MiB)
- LGBT ACA ENROLL Brochure (0.2 MiB)
- LGBT ACA ENROLL Presentation (1.6 MiB)
- LGBT ACA Provider Guide (0.7 MiB)
- Out2Enroll Covered Calfornia Presentation (1.9 MiB)