Medicaid Presented by Ron Lanton, Esq. Executive Director of Frier Levitt Government Affairs

Transcription

1 Medicaid 2019 Presented by Ron Lanton, Esq. Executive Director of Frier Levitt Government Affairs

2 Housekeeping The webinar will be recorded We will be answering questions at the end Please take the brief survey as you leave

3 Realizing Care s Potential

4 State scrutiny of managed care Medicaid: Approximately one-in-five Medicaid enrollees lives with a diagnosed mental health condition or substance use disorder. Priorities: To integrate physical and mental health services with an outcomes based approach to care. States: Depending on how the state approaches Medicaid expansion this relates to how overall spending and reimbursement are applied. States who have chosen to expand Medicaid have taken advantage of additional federal funds. The states who have not expanded are more likely to further limit Medicaid access.

5 The State of Mental Health Care

6 Medicaid Spending: Expected Medium Growth Rate

7 Work Status of Non-SSI, Non-Elderly Adult Medicaid Enrollees, 2016

8 State scrutiny of managed care What are waivers? There are two kinds of waivers that states are applying for at this time Waivers: Section 1115 of the Social Security Act gives the Secretary of Health and Human Services authority to approve experimental, pilot, or demonstration projects that promote the objectives of the Medicaid and Children s Health Insurance Program (CHIP) programs Waivers: Section 1332 of the Affordable Care Act (ACA) authorizes states to waive key requirements under the law in order to experiment with different health coverage models.

9 Poll Question How many Medicaid enrollees are diagnosed with a mental health condition? A. 1 in 7 B. 1 in 5 C. Over 1 million D. All of the above

10 Answer B. One in five

11 State scrutiny of managed care 1332 Waivers: What is reinsurance? Reinsurance is a risk mitigation program. It helps insurers in the state with losses from enrolling higher-risk populations with higher claims. This has been a way to keep insurers in the state s exchanges. Alaska, Hawaii, Minnesota, Oregon: All of these states have been approved with the exception of Hawaii, for a state-based reinsurance program. Maine: Is the latest state to apply for a 1332 waiver. They want to reinstate a previous reinsurance program.

12 State scrutiny of managed care 1115 Waivers: According to the Kaiser Family Foundation, State interest in behavioral health waivers, including mental health and substance use disorders, remains high. As of March 5, 2018, there are 19 approved and 13 pending behavioral health waivers in 26 states. Work Requirements: Some states have used the 1115 waiver to impose work requirements for those eligible for Medicaid. Medicaid Expansion: The waiver is also used for Medicaid expansion and for approval of other requirements. There are still states that are trying to expand such as Maine.

13 Main reasons for not working among non-ssi, Adult Medicaid Enrollees, 2016

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15 Insurance Status of Non-elderly Adults with Opioid Addiction, 2016

16 Past-Year Opioid Addiction Treatment Among Nonelderly Adults with Opioid Addiction by Insurance Status, 2016

17 State response to opioid crisis Many states have been dealing with the opioid crisis and need more funding. Current federal funding: 21st Century Cures and emergency funding Medicaid state demonstrations: Massachusetts: In November 2016, CMS approved a section 1115 demonstration project for Massachusetts that will strengthen the state s system of recoveryoriented SUD treatments and supports by covering a more comprehensive array of outpatient, residential inpatient and community SUD services to promote treatment and recovery as part of a statewide opioid action plan.

18 State response to opioid crisis West Virginia: In October 2017, CMS approved a section 1115 demonstration project for West Virginia that strengthens the state s SUD delivery system through expanded service coverage, including for methadone treatment, peer recovery supports, withdrawal management and residential treatment; introduces new programs to improve the quality of care, including requiring providers to deliver care consistent with national treatment guidelines; and establishes new care coordination features. West Virginia is implementing an extensive quality and performance measurement plan to monitor and report on the impact of the demonstration.

19 Employment Status and Income of Nonelderly Adults with Opioid Addiction, 2016

20 State response to opioid crisis State Legislation Limits on first fill prescriptions Narcan without a prescription PDMP

21 Medicaid Spending on Prescription Treatment for Opioid Use (millions)

22 Telehealth Telebehavior health: This is a new way to leverage technology in order to integrate primary care with mental health care. - Increased use of telehealth for mental health care because of shortage of providers. - Medicaid is looking for programs that cut costs. - New York Medicaid program

23 Federal Legislation S. 1732: Improving Access to Behavioral Health Information Technology Act, promotes the testing of incentive payments for integration of electronic health records. S. 2680: Opioid Crisis Response Act of 2018, This bill provides more funding for states. It is currently out of committee and is likely to pass both houses. H.R. 3192: CHIP Mental Health Parity Act, ensures parity for mental health services in the CHIP program.

24 What may happen next? Depending on the outcome of the November elections Medicaid reforms may move more toward cost cutting or expansion. -Possible return of block grant legislation -Texas vs. United States -Business Association Plans If the Democrats take back the House this may stop the possible return to repealing the ACA.

25 Realizing Care s Potential State Agencies AAAs Non-Profits Behavioral Health

26 Questions?