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

2. Medicaid Coverage in West Virginia1

3. West Virginia Medicaid in Working Families2

4. 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

5. SFY Medical Costs (Millions)
* Projected 4

6. An Epidemic in Evolution5

7. Neonatal Abstinence Syndrome (NAS)
Source: Healthcare Cost and Utilization Project (HCUP) – State Inpatient Databases 6

8. 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

9. Action vs. Inaction 8

10. SUD Waiver Overview
On November 22, 2016, the West Virginia Department of Health and Human Resources (DHHR) submitted a Medicaid Section 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

11. 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

12. 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.

13. 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.

14. 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.

15. 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.

16. 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

17. SED Waiver Timeline

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

20. 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:
Website: