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

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

3. Why focus on Behavioral health?

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

5. 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

6. Overview of Illinois’ 1115 waiver application

7. 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

8. 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

9. 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

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

11. Questions?

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

13. Cdc – the opioid epidemic by the numbers
Source:

14. 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

15. Medicaid’s Role

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. Questions?
Zina Gontscharow, MPP Senior Policy Analyst America’s Essential Hospitals