Wednesday, September 26, 2012

Integrating Behavioral Health Services

The State of Maryland’s draft report published August 2012, titled “Maryland Recommending an Integration Model for Medicaid-Financed Behavioral Health Services” describes the problems facing the state to help individuals with mental illness and also suffering from addiction.

According to the Substance Abuse and Mental Health Services Administration, only 7.4 percent of individuals in the U.S. with co-occurring disorders are treated for both conditions and more than half do not receive treatment for either.

In addition, many individuals with mental illness, addiction, or have a dual diagnosis, have significant chronic conditions such as diabetes or heart disease. These conditions are largely responsible for a 25 year gap in life expectancy between those with serious behavioral health disorders and those in other populations.

Many Marylanders suffer from mental illness, substance abuse and chronic health conditions, but the financing system that provides services in the state is fractured and consists of three paths:

  • One path is to access medical treatment and some behavioral health services in primary care through Medicaid
  • The second path is to access addiction services through local jurisdictional grants
  • The third path is to seek specialized mental healthcare through the Mental Hygiene Administration’s fee-for-service program
These disparate paths rarely meet to provide coordinated care for patients. The combined cost of medical, substance abuse treatment, and mental health care for high-cost individuals can reach hundreds of thousands of dollars per patient per year.

Since many private insurance options do not currently cover behavioral health services, low-income individuals that rely on publically-funded services have difficulty receiving appropriate care. Many low-income individuals are not eligible for Medicaid since they make too much money or do not have children.

Beginning in 2014, most individuals under 138 percent of the federal poverty line will be eligible for Medicaid under Medicaid Expansion. In addition, all health plans will be required to cover behavioral health services. This means that the need for grant-funded services will decrease as private and public insurance take its place. As a result of the changes under healthcare reform, Medicaid is going to be the predominant avenue to behavioral health services for individuals below the 138 percent federal poverty line.

Recently, the State of Maryland initiated several actions to deal with the issue:

  • A working group was convened by the Department of Health and Mental Hygiene to recommend how to develop a system of integrated care for individuals with co-occurring serious mental illness and substance abuse issues
  • The Department worked with stakeholders and engaged a consultant to examine options for the integration of Medicaid-Financed behavioral healthcare in the state
  • In early 2012, the state established a Steering Committee led by the Deputy Secretary for Health Care Financing to review the financing and integration options
  • Between March and September 2012, large public stakeholder meetings were held to discuss financing and integration models
Three documents describing three proposed finance and integration models to be considered for adoption by the state were developed by the Steering Committee and included in the draft report which has been circulated for comment.