On October 19th in Dallas, NASHP brought together a diverse group of state and federal Medicaid and mental health leaders to talk about emerging issues in the world of mental health, substance use, and recovery. True to its title, the pre-conference session “Whole Person Care: Finding Shared Solutions Across Mental Health, Substance Use, and Medicaid to Promote Recovery” highlighted how state policymakers are working across agencies and system silos to improve care and reduce cost for Medicaid enrollees with substance use and/or mental health disorders. Highlights on the theme of collaboration include:
- Arizona’s Medicaid agency, the Arizona Health Care Cost Containment System (AHCCCS) has worked closely with its Division of Behavioral Health Services to integrate physical and behavioral health services through that state’s 1115 waiver. Starting with Maricopa County and now expanding statewide, the AHCCCS is building a comprehensive, integrated service system that addresses the mental health, substance use, physical and social service needs of enrollees with serious mental illness. Reflecting this direction, the state is also in the process of merging the Division of Behavioral Health Services with the AHCCCS.
- Ohio’s Department of Mental Health and Addiction Services partnered with its Department of Medicaid to transition individuals under the age of 60 with mental illness from nursing home to community settings. The state partnership enabled Ohio to reinvest resources in the community toward transportation, housing and employment services; 348 Ohioans have benefitted from this effort since its inception in 2014.
- The Massachusetts Behavioral Health Partnership/Beacon Health Options (MBHP), which manages behavioral health for residents in the Massachusetts Medicaid program, MassHealth, partnered with the Massachusetts Housing and Shelter Alliance to implement a low-barrier housing and supports program for chronically homeless MassHealth members with mental health and/or substance use disorders. Through the state’s 1115 waiver, MBHP provides flexible community support services designed to meet the needs of people with behavioral health disorders who have struggled to maintain permanent housing. The Community Support Program for People Experiencing Chronic Homelessness (CSPECH) saves an estimated $10,000 per member annually and to date has served over 600 individuals.
- Connecticut’s Department of Mental and Addiction Services, working closely with its Department of Corrections, has developed an extraordinary array of programs and services at the intersection of mental health, substance use, and corrections. The state has developed cost effective programs for women, veterans, and individuals with substance use and/or mental health issues, as well as crisis and day support programs that help divert people with behavioral health needs away from the corrections system and into appropriate treatment programs.
Participants at the meeting agreed that cross-agency collaboration is critical in addressing the needs of Medicaid enrollees with behavioral health issues, who very often have complex needs and face barriers accessing services and supports from multiple systems. A few key takeaways and tips from the discussion:
There’s something in it for everyone: Medicaid, mental health, corrections, and other state agencies all have something to gain by collaboration, and opportunities to promote common interests abound: Medicaid agencies cannot address the needs of new expansion populations without mental health at the table; mental health and corrections policymakers have a clear alignment in assisting individuals with behavioral health needs both pre- and post-corrections involvement. Complex federal requirements, such as Olmstead community integration, span the purview of multiple agencies and call for a collaborative approach.
Look for critical issues and easy wins: State behavioral health policymakers often have trouble getting Medicaid to the table given the breadth of Medicaid’s responsibilities. Attendees noted that identifying small projects in areas of common concern can help to create some easy wins and forge successful relationships. Rather than major systems change, think pilot projects or joint contracting. Connecticut, for example, started its jail diversion work through a pilot program; data from that program fostered the spread of these services statewide.
Take a person-centered approach: Looking at service needs from the individual perspective can help state policymakers identify key partners. Create fictional profiles of users of various systems to better understand the barriers individuals and families face in accessing silo’d services and supports. Use these profiles to identify critical partners based not on what your agency does, but what a typical user of your system might need.
Leadership and commitment is vital: state policymakers emphasized that the culture of collaboration is bolstered by clear direction from the top, and that this collaboration takes time and effort. State policymakers – in Medicaid, mental health, and other agencies noted that leaders who can set the tone, build relationships, and stick with it are essential.
Start talking: State leaders advised convening cross-agency work groups – even if you are not quite sure what you are going to do yet. Identify areas of overlap and potential arenas for action and/or shared resources. Developing the infrastructure for collaboration can also help counteract the impact of turnover in leadership and administrations.
A complete set of slides and other resources from the NASHP pre-conference session are available here.