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Illinois seeks waiver to focus effort on behavioral health

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Illinois

Illinois’ Medicaid program would be able to cover housing, employment services and more intervention services under a proposal to bring $2.7 billion in new federal funds to the state for the care of people struggling with mental illness and substance abuse.

The five-year proposal from the administration of Gov. Bruce Rauner could help “change the trajectory” of many Medicaid recipients’ lives “by providing some needed resources,” said Felicia Norwood, director of the Illinois Department of Healthcare and Family Services. […]

As many as 800,000 Illinoisans could benefit as a result of the waiver, Norwood said Wednesday. She noted that 25 percent of the 3.2 million people covered by Medicaid have mental health issues or substance abuse problems or both.

Many of the people who would be served are new to the Medicaid program because of the expanded eligibility levels provided and funded by the federal Affordable Care Act, Norwood said.

Candidate Bruce Rauner opposed expanding Medicaid. But, what’s done is done.

* A prime focus is on behavioral health. From the waiver request…

The initial focus of the transformation effort is on behavioral health (mental health and substance use) and specifically the integration of behavioral and physical health service delivery. Behavioral health was chos en due to the urgency of the issue as well as the potential financial and human impact. Building a nation - leading behavioral health strategy will not only help bend the healthcare cost curve in Illinois but also help turn the tide of the opioid epidemic, r educe violent crime an d violent encounters with police, and improve maternal and child health. There is also a large financial payoff in improving behavioral health: Medicaid members with behavioral health needs (referred to henceforth as “behavioral health members” ) represent 2 5% of Illinois Medicaid members but account for 56% of all Medicaid spending […]

Illinois ranks 30th in mental health workforce availability with 844 people per mental health worker compared to the national median of 752 and the 25th percentile of 520. Illinois ranks 32nd and 31st in the nation in pre-term birth and violent crime rates, respectively, both of which have links to behavioral health. Lastly, Illinois ranks 41st in the nation in mental health service coverage for children, with just 45% of children who need services receiving them. Given the State’s overall spending on the behavioral health population, these results demonstrate clear room for improvement.

posted by Rich Miller
Thursday, Sep 8, 16 @ 10:58 am

Comments

From page 2 of the article:
“But Howe said the overall proposal represents a “huge disconnect” in light of the state budget-related financial struggles faced by many behavioral health providers during a statewide and nationwide epidemic of heroin and opioid addiction.”
*****
THIS! Freezing all contracts in 2015, stopping/delaying payments to providers, sitting by and watching them struggle or go under… ALL of this may come back on bite the Rauner Administration hard when the proposal is considered in DC.
*****
Again, from the article:

“The proposal says efficiencies and other savings set in motion by the improvements would offset the additional federal spending.

Howe said she has doubts that federal approval and implementation will take place as soon as mid-2017, and it’s unknown whether behavioral health providers will be financially healthy enough to carry out the waiver proposal.”

Comment by Anon221 Thursday, Sep 8, 16 @ 11:15 am
Candidate Rauner may have been against the Medicaid expansion, but Governor Rauner has depended on it to justify eliminating scores of healthcare programs funded by GRF by moving those patients over to Medicaid which is 95% federally funded, thereby saving the State of Illinois hundreds of millions of dollars.

However, it also created an unfair attack that Rauner was eliminating healthcare programs when he really was moving it from a state-funded responsibility to a federal-funded one.

Comment by Just Me Thursday, Sep 8, 16 @ 11:17 am
(A lot of healthcare advocacy groups got a ton of PR and raised a ton of money based on those “cuts.”)

Comment by Just Me Thursday, Sep 8, 16 @ 11:18 am
Reading the full waiver request, it appears the $2.7 billion fed money would go for “transformations” and “integration” of services among 12 state agencies.

In other words, agency operating costs, not health care.

Can’t blame them for trying.

Comment by Anonymous Thursday, Sep 8, 16 @ 11:19 am
The waiver is a good idea. Let’s hope their are good plans to use the freedom.

One problem with Federal money is that it comes with Federal strings. The Feds don’t trust the States, so they specify minimum levels of care. Unfortunately, we don’t know how to fix many of these problems. Federal oversight ends up locking the States into ineffective programs.

President Reagan tried to encourage innovation through block grants. Vestiges of these remain, but most often the Congresscritters have moved the power back to Washington.

Comment by Last Bull Moose Thursday, Sep 8, 16 @ 11:22 am
The past 18 months have decimated the mental health system in Illinois, mostly a result of the budget impasse. Many community mental health centers cut staff or closed down entirely. It is unlikely the system can recover to what it used to provide. I’ll be glad if they can get some federal funds to try to restore services though. I don’t for a second think this is about wanting good service, though. It is about tapping into federal dollars.

Comment by Anonymous Thursday, Sep 8, 16 @ 11:25 am
“One problem with Federal money is that it comes with Federal strings.”

Like a State match of some percentage. Where is 1.4% going to find that money?

Comment by Huh? Thursday, Sep 8, 16 @ 11:38 am
Anonymous11:25 has it right BigBrain has crushed the mental health treatment. It is also important to remember that community based treatment is an important element to the BigBrain early release plan for DOC.

Comment by Annonin' Thursday, Sep 8, 16 @ 11:48 am
good idea, but how about funding the social services for drug treatment and mental health that are closing or have closed! this doesnt seem to fit the anticollectivist mantra either….

Comment by Ghost Thursday, Sep 8, 16 @ 12:15 pm
so how can these funds be used to address the needs of felons? As noted above, the goal of reducing the prison population by 25% is completely dependent on breaking the cycling of those with mental health and substance abuse issues through the criminal justice system. How many felons are eligible for Medicaid, housing and treatment?

Comment by Anonymous Thursday, Sep 8, 16 @ 12:35 pm
After reading the waiver request:
1. No mention of rates or rate adjustments
2. Huge need for more psychiatrists and detox/drug rehab, guess what funding got cut in the last budget.
3. Huge need for residential/housing services. Who will put up the cash for homes and staff when many grants have not been paid for months?
4. Moving toward community based programs. Where will providers find good staff when multiple bills to raise basic service salaries were just vetoed?

Comment by z Thursday, Sep 8, 16 @ 2:29 pm
- Z - You’re confusing your programs there, my friend. This post is about Medicaid.

Comment by Not It Thursday, Sep 8, 16 @ 2:45 pm