Behavioral Health Integration and the Affordable Care Act after 5 Years


The Affordable Care Act (ACA) was signed into law 5 years ago. In the time since its passage, the ACA has increased the number of Americans with health insurance, increased access to affordable health care, and may be contributing to slowing the rate of increase in health care spending.1 In addition, the ACA has transformed the delivery of health care,1 including changes that advance primary care and behavioral health integration. Among the post-ACA initiatives enabling opportunities for transformation through the integration of primary care and behavioral health are:

  • State Innovation Models (SIMs) – Provides Federal dollars and technical assistance to help states and private payers provide better care at lower costs
  • State Plan Amendments (SPA) – Sixteen states have agreements with the Federal Government that relate to the integration of primary care and behavioral health within Medicaid and the Children's Health Insurance Program CHIP administration
  • Independence at Home Demonstration (IAH) – An Innovation Center program to test the effectiveness of delivering team-based comprehensive primary care services at home to high-need Medicare beneficiaries
  • Medicaid Innovation Accelerator Program (IAP) – Technical assistance program launched that supports states in accelerating payment and delivery system reforms for Medicaid beneficiaries relating to issues such as substance use disorders and mental and physical health integration
  • Comprehensive Primary Care Initiative (CPCI) – A program that supports innovative health care payment and organization models, including some that focus on care-coordination and chronic disease management
  • Multi-Payer Advance Primary Care Practice Demonstration (MAPCP) – A demonstration program that provides a monthly care management fee for Medicaid beneficiaries who receive care from patient-centered medical homes.

For additional information, view the following resources:

  • ACA Payment and Delivery Reform Systems at 5 Years – An issue brief from the Commonwealth fund
  • Summary of Select Affordable Care Act Payment and Delivery System Reform Provisions – A supplemental table describing ACA reforms from the Commonwealth Fund
  • The Affordable Care Act at 5 Years – A New England Journal of Medicine article
  • Healthcare Integration in the Era of the Affordable Care Act – A report (PDF - 791.53 KB) from the Association for Behavioral Health and Wellness

1Blumenthal D, Abrams M, Nuzum R. The Affordable Care Act at 5 Years. N Engl J of Med. 2015 Jun 18; 372(25): 2451-8. PMID: 25946142