Illinois HFS Ready to Open Public Comment on Medicaid Behavioral Health Transformation Waiver Extension – State of Reform

The Illinois Department of Healthcare and Family Services (HFS) announced May 19 as the first of its three public hearing dates on Friday to solicit input on a draft proposal to extend Medicaid 1115 waiver for behavioral health transformationalso known as Better Care Illinois Behavioral Health Initiative (BCI).

HFS is seeking a five-year extension of BCI, which ends in late June, to build and expand the program’s current service capacity of 3,000 members annually to potentially serve the state’s entire Medicaid population through a wide range of health-related social services needs of services, such as food, job assistance, housing and medical respite services.

The proposed extension contains new programs focused on health equity, including grants for safety-net hospitals, training for community health workers, culturally and linguistically appropriate care management,

The proposal addresses Illinoisans who are pregnant, homeless/housing, embroiled in justice, unemployed, food insecure, and those in need of violence and crisis intervention.

HFS is seeking an annual spending authority of 3 percent of the state’s total Medicaid spending, an additional annual spending authority of $900 million for the new initiative. Estimated expenses for the services proposed in the five-year period amount to 7.9 billion dollars.

Proposed initiative includes Healthcare Transformation Collaboratives, which aim to refocus Illinois’ health care delivery system around people and communities to be more equitable and close gaps in health care access, quality, and outcomes .

HFS will lead three public hearingsin Chicago, Springfield, and one held virtually aimed at garnering support for the proposal.

In an interview with State of Reform, Kelly Cunningham, Medicaid administrator at HFS, said public acclaim and support were important in gaining federal approval for the proposed demonstrations to serve Illinois’ most vulnerable.

[The] The 1115 waiver is actually a demonstrative waiver [where] propose a hypothesis, a bit of a scientific experiment in terms of how the results you want to see impact your population, Cunningham said. In getting a waiver like this approved, the federal government wants to know that the community, the people who will benefit from the services, stands behind it.

Cunningham said CMS approval is the first hurdle to clear, after which HFS will enter a period of negotiating terms and conditions and operational protocols that speak to implementation. The hearings will set the stage for when that implementation phase occurs.

BCI is a set of 10 initiatives of the pilot program approved by CMS in 2018 integrate physical and behavioral health services to better serve Medicaid beneficiaries with substance use disorders (SUDs) and severe mental health issues through value-based contracts and care coordination.

Initiatives include a pilot project on SUD’s case management that diverts people from the criminal justice system to treatment.

Operational delays and issues related to the COVID-19 pandemic, such as staff shortages and service shutdowns, resulted in HFS being able to implement only four of the original 10 SOUTH-related pilot projects, as well as a lower commitment than expected. Despite these challenges, HFS said preliminary interim evaluation data indicates that 39% of performance metrics met initial expectations with notable progress shown over the past two years.

Two of the six suspended Community Integration and Employment Assistance programs are included in the extension, while the remaining four covering Housing, Respite, and Crisis Assistance will transition to State Plan Authority as part of the extension. of the program Pathways to success program.

Cunningham spoke about the lessons learned over the past five years that have helped inform the proposed waiver framework.

I think one of the most important lessons we learned was that we needed to change our approach to working with providers who don’t traditionally provide Medicaid services as community-based organizations, Cunningham said. They may have specific expertise in housing support or employment support or violence prevention.

But those aren’t traditional Medicaid services, so we’re really trying to be as flexible and creative as possible to educate about what it means to be a Medicaid provider, provide technical assistance, and support them in ways that make the Medicaid environment more friendly. Because we know trying to sign up as a new vendor can be daunting [and] determine how to bill and how to work with a managed care plan.

At the end of the public comment period, HFS says it will complete and submit its application to CMS before the current waiver deadline date of 26 June.