West Virginia Medicaid Summit Cynthia Beane, MSW, LCSW Commissioner September 17, 2018

Medicaid Coverage in West Virginia 1

West Virginia Medicaid in Working Families 2

Bureau for Medical Services Non-Appropriated Special, 49,368,770 1% General Revenue, 587,391,497 13% General Revenue Federal Revenue Appropriated Special, 300,249,316 7% Federal Block Grant Appropriated Special Non-Appropriated Special Total Budget State Fiscal Year (SFY) 2019 $4,491,583,784 Federal Revenue, 3,554,574,201 79% *Projecting approximately $51 million in SFY 2019 to serve as a reserve that will otherwise roll into next year to balance SFY 2020. 3

SFY Medical Costs (Millions) * Projected 4

An Epidemic in Evolution 5

Neonatal Abstinence Syndrome (NAS) Source: Healthcare Cost and Utilization Project (HCUP) – State Inpatient Databases https://mchb.tvisdata.hrsa.gov/PrioritiesAndMeasures/NationalOutcomeMeasures 6

Foster Care and Congregate Care Placements Total Number of Foster Care and Congregate Care Placements 7000 6000 5000 4000 3000 2000 1000 2012 2013 2014 2015 2016 2017 2018 7 Total Congregate Care Total Placement

Action vs. Inaction 8

SUD Waiver Overview On November 22, 2016, the West Virginia Department of Health and Human Resources (DHHR) submitted a Medicaid Section 1115 Waiver application to the Centers for Medicare and Medicaid Services (CMS). This was approved on October 6, 2017. The Waiver allows BMS the opportunity to test innovative policy and delivery approaches to reform systems of care for individuals with Substance Use Disorders (SUD) in West Virginia. West Virginia will use the Medicaid Section 1115 Waiver to develop and implement a continuum of SUD treatment benefits designed to address the immediate and long-term physical, mental, and social needs of individuals, and to promote and sustain long-term recovery. 9

SUD Waiver Implementation Key expansions in Medicaid coverage designed to support and augment West Virginia’s continuum of care: Phase 1 implemented January 14, 2018 The Screening, Brief Intervention, and Referral to Treatment (SBIRT) Expanded Medication Assisted Treatment (MAT) to include methadone Comprehensive initiative for distributing naloxone (Narcan®) Phase 2 implemented July 1, 2018 Expanded coverage of withdrawal management Adult residential substance abuse treatment to include all levels of American Society of Addiction Medicine (ASAM) Peer recovery support services 10

CMS Approval NAS Services DHHR’s Bureau for Medical Services (BMS) received approval effective October 1, 2017, from CMS to offer NAS treatment services, making West Virginia the first state in the nation to receive such approval. The intent of the NAS Treatment Center is to reduce or prevent symptoms of withdrawal in newborns who have been prenatally exposed to addictive drugs using both pharmacological and non- pharmacological interventions. The approval for NAS services in West Virginia will enable newborn babies after discharge from the Neonatal Intensive Care Unit (NICU) or hospital who may have a need for continued weening from an opioid substance in a safe environment which will promote optional functioning of the baby and continued medical weening protocols.

Care Management Concept Develop a contract for an array of services for children in foster care and children at risk of entering foster care. Link various Federal funding sources to maximize resources and ensure continuity to infrastructure is developed. Manage social service needs and medical needs of children and families under one contractual arrangement. Create additional resources for circuit judges, prosecutors, law enforcement and child protective services to maximize supports for children in need.

Efforts in Oversight Management Improve coordination of wraparound and other services. Improve clinical oversight in order to allow the most appropriate care. Ensure that medical records follow a member wherever they receive services. Improve coordination with medical providers and social services so that those endeavoring to assist members have coordinated and up-to-date information.

Children with Serious Emotional Disturbance BMS is currently sponsoring a project to develop a waiver under the Home and Community-Based Services (HCBS) program authorized under§1915(c) of the Social Security Act for Children with Serious Emotional Disturbance (SED). The SED Waiver will provide services that are additions to Medicaid State Plan coverage for children with SED who are enrolled in the SED Waiver program, up to the child's 21st birthday. The SED Waiver will permit a targeted, individualized planning process developed by child and family teams to serve children who may be involved with multiple child-serving systems; who are at risk of out-of-home placement; and/or who are served through other mental health services and community-based options with limited success.

Potential SED Waiver Services Respite Child therapeutic foster care Community living supports Family support and training Services coordination Crisis intervention Direct behavioral support Family therapy

SED Waiver Timeline

“The best way to predict the future is to create it.” ~ Abraham Lincoln

Contact Cindy Beane, MSW, LCSW Commissioner West Virginia Department of Health and Human Resources Bureau for Medical Services 350 Capitol Street, Room 251 Charleston, WV 25301 Phone: 304-558-1700 Email: Cynthia.E.Beane@wv.gov Website: www.dhhr.wv.gov/bms