Illinois’ 1115 Behavioral Health Transformation Waiver America’s Essential Hospitals - VITAL 2017 June 22, 2017 Douglas Elwell CCHHS Deputy CEO for Finance and Strategy

Presentation Outline Why Focus on Behavioral Health? Overview of Illinois’ 1115 Waiver Application Issues to Watch Questions?

Why focus on Behavioral health?

Why focus on behavioral health? Source: HFS FY15 Claims Data

Why focus on behavioral health? (cont’d) Costliest 10% of Medicaid beneficiaries account for 72% of behavioral health spend Medicaid beneficiaries with behavioral health needs are 3.5 times as likely to have a chronic condition and cost twice as much to treat and manage compared to those without behavioral health needs 37% of Medicaid behavioral health problems are treated but undiagnosed or diagnosed and not treated Source: HFS FY15 Claims Data

Overview of Illinois’ 1115 waiver application

Waiver Goals Reduce over-reliance on institutional care and shift to community-based care Promote integration of behavioral and physical health Support development of robust and sustainable behavioral health services that provide both core and preventive care Invest in social services to address the larger needs of those with behavioral health needs, including housing and employment services Move behavioral health providers toward outcomes- and value-based payments

Waiver Initiatives and Activities Create infrastructure and funding for behavioral and physical health integration Strengthen workforce Expand social services Focus on the justice-involved Improve mental health and substance use disorder treatment and services Provide new services for vulnerable children and their families

Additional Details Draws down a total of $2.7B in federal match ($1.2B directly from waiver, $1.5 from proposed State Plan Amendment) Waiver application submitted October 5, 2016 with anticipated start date July 1, 2017 Several State Plan Amendments submitted and pending Waiver workgroup convened and meeting on bimonthly basis

Issues to Watch State Budget Impasse Medicaid Managed Care Future of Medicaid Expansion Behavioral Health Reimbursement Rates

Questions?

Medicaid and the Opioid Epidemic Zina Gontscharow, MPP June 22, 2017 3:00 – 3:30 PM

Cdc – the opioid epidemic by the numbers Source: https://www.cdc.gov/drugoverdose/epidemic/index.html

An administration priority President’s Commission on Combating Drug Addiction and the Opioid Crisis Department of Health & Human Services Strategy HHS Listening Tour Source: newyork.cbslocal.com

Medicaid’s Role

Disproportionate IMPACT on medicaid MACPAC’s June Report found that: Medicaid beneficiaries age 18–64 have a higher rate of opioid use disorder than privately insured individuals Medicaid beneficiaries are prescribed pain relievers at higher rates than those with other sources of insurance They also have a higher risk of overdose and other negative outcomes, from both prescription opioids and illegal opioids such as heroin and illicitly manufactured fentanyl But Medicaid beneficiaries with an opioid use disorder have higher treatment rates than privately insured adults with the same condition

Disproportionate impact on medicaid The Medicaid and CHIP Payment and Access Commission (MACPAC) reported that: New York State found that Medicaid enrollees were prescribed painkillers at twice the rate of non-Medicaid patients Washington State found that Medicaid patients were at three to six times the risk of prescription painkiller overdose compared to the population as a whole Arizona study found that Medicaid paid for more than half of all opioid-related emergency department admissions in the state in 2010

Medicaid’s response Coverage of diagnosis and treatment for opioid use disorders Screening and early intervention Overdose prevention Medication-assisted treatment (MAT) Medications Behavioral therapies ASAM Criteria to determine appropriate care settings Recovery support services

Medicaid innovation States are using a variety of options within the Medicaid program to pursue innovative strategies to combat the epidemic: Section 1115 waivers Section 2703 Health Homes option State plan rehabilitation option Section 1915(i) state plan option for home- and community-based services

Signals from new administration Leveraging Section 1115 opportunities for greater innovation and funding July 2015 letter to State Medicaid Directors March 2017 letter to Governors CMS’ expectations for transformation: Comprehensive evidence-based benefit design Appropriate standards of care Strong network development plan Care coordination design Other strategies to prevent and treat opioid use disorders

State innovations Virginia: Medicaid Addiction and Recovery Treatment Services Vermont: Care Alliance for Opioid Addiction Ohio: Maternal Opiate Medical Support (MOMS) Project Texas: Rehabilitation Option

Questions? Zina Gontscharow, MPP Senior Policy Analyst America’s Essential Hospitals 202.585.0113 zgontscharow@essentialhospitals.org