The Affordable Care Act and Place-Based Community Work

On June 28, 2012, the Supreme Court upheld the Patient Protection and Affordable Care Act (ACA) as constitutional, meaning the law is legal and will mostly be implemented as originally written. Many experts predict that the ACA will have a concrete impact on every American individual, but what about communities and community work? As states strive to meet upcoming ACA implementation deadlines, how will place-based initiatives and their constituents be affected?

Going beyond Coverage to Improve Community Health is the first in a series of CSSP Issue Briefs that examine how place-based initiatives can harness ACA resources and programs to maximize community health. Some of the new or enhanced programs, initiatives and funding streams authorized by the ACA and highlighted in CSSP’s Issue Brief are described below: 

• Community Transformation Grants (CTG) are intended to combat health disparities and chronic illness by empowering local communities to recognize and address social determinants of health outcomes. Grantees will focus on reducing health disparities and chronic disease rates through targeted disease prevention and health promotion initiatives. CTG is also dedicated to supporting and expanding evidence-based strategies. Roughly $103 million CTG funds have been awarded thus far. Grantees for the small communities program will be announced in September 2012. See here for more information about CTG.

• The National Prevention, Health Promotion and Public Health Council, an inter-agency coalition of 17 federal departments, models the cross-sector collaboration that many place-based initiatives also operationalize. The Council’s first report, National Prevention Strategy: America’s Plan for Better Health and Wellness, highlights four strategic directions for prevention-oriented work, listed below, and serves as a guide for how communities can implement prevention strategies.

Strategic Directions for Prevention-Oriented Work:

1. Healthy and safe community environment
2. Clinical and community preventive services
3. Empowered people
4. Elimination of health disparities

The National Prevention Strategy has also defined seven priorities:

1. Tobacco Free Living
2. Preventing Drug Abuse and Excessive Alcohol Use
3. Health Eating
4. Active Living
5. Injury and Violence Free Living
6. Reproductive and Sexual Health
7. Mental and Emotional Well-Being

• In order to maintain their tax-exempt status, non-profit hospitals will now be required to conduct a periodic community health needs assessment and demonstrate concrete action to address identified needs. The needs assessment process must be public knowledge and will provide opportunities for place-based initiatives and community organizations to partner with local hospitals.

• The ACA enhances the evidence-based, two-generation Maternal, Infant and Child Home Visiting Program. ACA funding to states and native tribes will be partially categorical and partially competitive. As part of the application process, states must conduct a needs assessment, identify at-risk communities and assess home visiting programs already operating in the state. While this year’s funds have already been allocated, stay tuned for the $400 million that will be available through this program in FY 2013. 

• The ACA requires every state to launch a culturally competent and linguistically diverse Navigator program to assist individuals/ families enrolling in health insurance through their state Health Insurance Exchange (“a new ‘health insurance marketplace’ created by the ACA that is designed to offer a range of affordable, quality insurance coverage options to individuals and families”). Navigators are tasked with encouraging health insurance enrollment and ensuring that consumers have full and accurate information about their options.  

• Through the new Community Health Center Trust Fund, the ACA will support federally qualified health centers (FQHCs) in an effort to bring them to greater scale and to encourage the development of new FQHCs in medically underserved communities. FQHCs already have a measurable impact, currently serving roughly 20 million uninsured patients. The first round of Community Health Center Trust Fund grantees was announced in May 2012.

• The School-based Health Center Capital Program will fund capital improvements to school-based health centers (SBHCs), prioritizing schools with high Medicaid- and CHIP-eligible student bodies. SBHCs often serve students’ families and neighbors in addition to the students themselves and present an opportunity to link clinical health to other community or school initiatives.

• New networks known as Accountable Care Organizations (ACOs) will provide targeted, coordinated, continuous care, including primary and specialty medicine. ACOs will structure payment based on outcomes, rather than the amount of services provided and will be closely linked to the communities served.

For more information and a full list of ACA opportunities applicable to place-based initiatives, see CSSP’s Issue Brief: Going beyond Coverage to Improve Community Health.