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* Sun-Times…
Gov. Bruce Rauner on Monday announced the federal government has approved a state Medicaid waiver that will allow community-based service providers to provide more care for patients with substance abuse and other mental health problems.
The waiver, which was more than two years in the making and includes 10 pilot programs, will provide services that are not currently covered by Medicaid, Felicia Norwood, director of the state Department of Healthcare and Family Services, said Monday at a West Side press conference. And it’s aimed at getting patients continual care instead of having them go to pricey emergency rooms or institutions.
“I personally believe this is maybe one of the most important days in the history of public health for the state of Illinois, anywhere in our state’s history,” Rauner said.
The initial focus of the program will be behavioral health, both mental health and substance abuse, and that was chosen “due to the urgency of the issue as well as the potential financial and human impact,” the state’s department of Healthcare and Family Services said in a fact sheet. The goals are to help stem the opioid epidemic, reduce violent crime and violent encounters with police and improve maternal and child health.
This waiver has been sought for years, starting with Gov. Quinn. It’s a very big thing.
* Illinois News Network…
Gov. Bruce Rauner announced Monday that the federal government has approved $2 billion in Illinois-directed Medicaid funding for the use of programs focusing on behavioral health conditions and addiction treatment via a 5-year pilot program named Better Care Illinois. Without the waiver, the money couldn’t be used in this manner.
Rauner says the waiver will allow the state to care for the whole person while finding savings in the Medicaid system.
“We believe that this will save huge amounts of taxpayer funding while improving the quality of mental health and total health for the people of Illinois,” he said.
* Those savings won’t be realized right away, of course. It will take time to implement the programs and lots more time for the programs to work as intended…
Rauner said one in four Medicaid recipients have behavior health conditions. They account for 52 percent of Medicaid spending.
“We are going to change the way our services are provided up front,” Gov. Bruce Rauner said. “That will save money over the five-year waiver program, and we’re going to then reinvest those savings back in the program and then drive major savings in the future subsequent to the five-year waiver.”
So some savings within five years and then “major savings” after five years.
* With that in mind, check this out from yesterday’s IDHS bullet points…
What is budget neutrality?
The federal government requires the demonstrations to be “budget neutral,” meaning that during the course of the waiver Medicaid expenditures cannot exceed what they would be without the waiver. The 1115 waiver is not a grant but rather an opportunity to use Medicaid dollars differently to increase the efficiency and quality of care for Medicaid populations.
That link and language was provided by a commenter, who asked…
Question for the Governor: since the overall state spending of federal dollars cannot increased, what will he be cutting out of current Waiver spending in order re-direct money to the pilot programs, or is he planning to use money out of GRF that receives no federal match for the pilots and what will he then cut out of GRF to pay for that?
* More…
The state has five years of flexibility for how it spends $2 billion. It’s a fraction of Illinois Medicaid spending, which is about $21 billion a year.
In other words, they’ll be repurposing about ten percent of current Medicaid spending. It’s actually 2 percent per year for five years…
$1,997,670,906 in repurposed spending over 5-years… So we’re talking about 2%, not 10%.
posted by Rich Miller
Tuesday, May 8, 18 @ 10:28 am
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The concept makes complete sense, to get to the root causes of a lot of very expensive emergency room visits.
Competent management should be able to find savings of $2 billion over five years, so let’s shoot for doing it right.
But, since TII, let’s keep an eye on who’s running the pilot programs, to make sure it’s not just some pork for political cronies.
Comment by wordslinger Tuesday, May 8, 18 @ 10:38 am
Finally some good news.
Comment by Da Big Bad Wolf Tuesday, May 8, 18 @ 10:52 am
Rich, couple things. 1, the 1115 waiver that Governor Quinn proposed was technically a different proposal to do different things. It was a 1115 proposal, but a different one.
And there doesn’t have to be any redirecting of funds from other Medicaid waivers. The cost neutrality is per person compared to what the person would have cost without the waiver. So if a person would have cost $10,000 in hospital stays, and the waiver gave them community services that deflected them from the hospital costing $2,500, you saved $7,500. That’s the cost savings they are talking about, not cutting other services to fund the waiver.
Page 13 of this document talks about where the savings are projected to come from at a high level https://www.illinois.gov/hfs/SiteCollectionDocuments/BetterCareIllinoisFAQs.pdf
Comment by Anonymous Tuesday, May 8, 18 @ 10:55 am
I think the $2 billion is over the course of 5 years total, not per year, so it’s not 10%.
Comment by Perrid Tuesday, May 8, 18 @ 10:58 am
Waiver request is here: https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/il/il-behave-health-transform-pa.pdf
$1,997,670,906 in repurposed spending over 5-years.
Total projected spending over those 5 years: $96,301,471,827
So we’re talking about 2%, not 10%.
Comment by JI Tuesday, May 8, 18 @ 11:16 am
I foresee some creative “savings” calculations in the coming years but good job to the rauner admin for getting this done. From past history I’m sure the next step is to get Deloitte involved to mess it up.
Comment by Anonymous Tuesday, May 8, 18 @ 11:18 am
Two percent is still a lot of money. I was involved with a smaller pilot program at DCFS. Acquiring good data was difficult. Analysis was tricky. The pilot program showed DCFS fundamentally misunderstood what was happening with a segment of the population served.
When leadership changed, the program died, and DCFS reverted to traditional thinking and practice.
The waiver is a good idea, but I have low expectations for beneficial change as Rauner is a worse manager than Quinn.
Comment by Last Bull Moose Tuesday, May 8, 18 @ 11:40 am
If GovJunk gets his way on cutting rates it is unlikely anyone will be treated
Comment by Annonin' Tuesday, May 8, 18 @ 11:52 am