The Patient Protection and Affordable Care Act (PPACA): Key Considerations for Social Work Practice
August 20, 2013
The PPACA directly impacts the role of social workers, especially those working in HIV care settings. The fluctuating landscape of medical, mental health, and supportive services as a result of the PPACA calls for social workers to be actively engaged in the enhancement of human well-being, to provide access to basic resources, and to ensure that the vulnerable, oppressed, and impoverished are included in an environment in which they feel empowered to achieve self-efficacy.
- Opportunities to obtain health insurance coverage are quickly approaching; professional competence is critical in assisting individuals with obtaining the best possible health insurance coverage available under the PPACA. Social workers should consider two first-order tasks: gain competence to discuss relevant health reform topics and increase knowledge of related information and referrals for individuals eligible for health insurance coverage.
- Become familiar with reputable PPACA resources covering everything from basic enrollment dates to the complexities of coverage limits for HIV and other chronic conditions:
- Department of Health and Human Services: https://www.healthcare.gov/
- Centers for Medicare and Medicaid Services: http://www.cms.gov/
- Kaiser Family Foundation: http://kff.org/
- National and local AETCs: http://www.aidsetc.org/
- National Association of Social Workers: http://www.socialworkers.org/
- Professional Association of Social Workers in HIV and AIDS: http://www.paswha.org/
- Find out if your state is expanding Medicaid coverage and how to apply for coverage in the Marketplaces. Individuals, including social workers, will be trained as Marketplace Navigators, Certified Application Counselors, and In-person Assistors for Marketplace enrollment.
- Targeted outreach interventions may be required to reach those who have historically faced a lack of access to basic resources. Many will be eligible for coverage under Medicaid or in the Marketplaces, and social workers should ensure that the impoverished, racial and ethnic minorities and those with complex medical, mental health, and substance use histories are not overlooked.
- While expertise in all health reform-related topics is not realistic, the ability to connect individuals with appropriate resources is an expectation of the social work profession. Individuals are often informed by their healthcare providers about available resources intended address an array of unmet needs. Experience has demonstrated that simply being told to “apply for disability” or “fill out a Medicaid application” in the absence of providing resource education, navigation assistance, and addressing the individual’s competing priorities often results in low linkage rates to needed services. For example, an individual ready to address his/her substance misuse issue might greatly benefit from the substance abuse treatment services covered by health insurance. Social workers are instrumental in helping both the care team and the individual in need to understanding the importance of the coverage, ensuring application completion, explaining how to access covered substance abuse treatment services, and addressing transportation, housing, childcare, or other barriers standing in the way of securing and utilizing health insurance coverage.
- Many individuals receive medical care and/or services through a public hospital system or a Ryan White-funded entity. Because these individuals may feel their care has been “free” (not requiring insurance or significant payment), they may need help understanding the importance of health insurance. Addressing this, and the potential for expanded options once insured is an important part of the process.
- Reimbursement for social work services varies by insurance plan and state. While minimum standards for mental health, substance abuse, and chronic disease management have been determined using Essential Health Benefits, insurance plans and states’ decisions to expand Medicaid will vary state-to-state. Reimbursement of social work services should be thought about strategically in times of unknown funding; advocating for states to put into place mechanisms ensuring access to social work services is of utmost importance in preparing for a system less dependent on grant-funded services.
We want to hear from you—in what other ways does a changing landscape of health care access due to the PPACA imply adaptations in the roles of social workers providing HIV services?