Healthcare overhaul could improve mental health services in San Mateo County 

click to enlarge San Mateo County is enrolling patients into health programs in anticipation of the Affordable Care Act.
  • San Mateo County is enrolling patients into health programs in anticipation of the Affordable Care Act.

The federal Affordable Care Act may provide substantially improved health care options for thousands of San Mateo County residents in need of mental health and substance abuse treatment, driving down the incurred costs of emergency services for such individuals, officials said.

One part of the federal law, which is also commonly referred to as Obamacare, will provide patients in need of behavioral health treatment with access to primary care. Such access will not only reduce the number of costly emergency room visits -- each visit running in the thousands -- but also prevent and curtail more serious problems before they occur, according to a San Mateo County Health System official.

The county's Behavioral Health and Recovery Services -- a part of the Health System -- treats about 17,000 patients for both mental illnesses and substance abuse, said Stephen Kaplan, director of the agency.

Of the 17,000, more than 1,500 new patients have been enrolled in transition programs in preparation for the Affordable Care Act's start date Jan. 1, Kaplan said.

"Many people we're talking about did not have access to primary health care services," Kaplan said, "and that helps us treat the whole person, not only when it becomes an emergency."

The county will be expanding Medicaid to people earning 138 percent of the federal poverty line, adding federal dollars the county will be able to use to expand services over time, Kaplan said.

According to Kaplan, the cash saved from avoiding preventable ER visits lets the county reinvest those dollars into programs -- not just bandage solutions -- that may have a more substantive effect in the long run.

The new federal legislation also creates many incentives for the motley collection of health care players in the county -- including private companies -- to integrate various services and work together in other ways. Integration is vital to successful behavioral health programs, Kaplan said.

"This county has a great history of strong collaboration between key partners," Kaplan said.

Overall in the county, there are 82,752 residents under age 65 without health insurance, or about 13 percent of the total population, according to U.S. Census data. Of the uninsured, about 47,000 will likely qualify for government or private coverage under the Affordable Care Act, Health System officials said.

But reaching out to those who may benefit from the law has been a challenge for county officials.

"There are still a lot of folks who don't understand the law," said Srija Srinivasan, director of strategic operations for the Health System. "And there's a communication challenge to reach them."

The Health System was able to get a head start on enrolling patients -- beginning over a year and a half ago -- in the behavioral health unit due to special federal waivers for which the state and county governments applied.

While outreach to patients with behavioral health illnesses is often more difficult, Kaplan said the year and a half of outreach has located many -- but not all -- of those who may benefit under the new health care law.

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