Illinois seeks flexibility in addiction, mental health care for Medicaid recipients

Illinois seeks flexibility in addiction, mental health care for Medicaid recipients

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SPRINGFIELD — Illinois is seeking permission from the federal government to use Medicaid funding to pay for substance abuse and mental health services that typically aren’t covered under the health insurance program for the poor.

Gov. Bruce Rauner’s administration is seeking a five-year waiver from certain Medicaid rules as part of its proposed “health and human services transformation,” which aims to provide services to the state’s most vulnerable residents more efficiently and cost-effectively by focusing on preventative care, public health and community-based programs and encouraging cooperation among state agencies.

The waiver, which wouldn’t expand eligibility or increase the amount of federal funding the state receives, would allow Illinois to test new ways of providing services to Medicaid recipients with mental illness and substance abuse problems. While those recipients make up about 25 percent of the 3.2 million Illinoisans receiving Medicaid, they account for 56 percent of spending in the $18 billion-per-year program.

“The way that we’re spending our scarce resources now is not producing outcomes that are good for the citizens of Illinois, and we need to do something about that,” James Dimas, secretary of the state Department of Human Services, said Thursday at a public hearing on the proposal in Springfield. “We have for decades over-relied on deep-end institutional care, and that has prevented us having the resources that were needed to invest in community-based and preventive care.”

Under the state’s proposal, Medicaid money could be used to pay for services such as supportive housing for people with mental illness, job support for people with substance abuse problems and certain medication-based addiction treatments for inmates nearing release from state prison.

The proposal places a particular emphasis on substance abuse treatment at a time when the state is battling a heroin- and opioid-addiction crisis. From 2007 to 2012, state-funded treatment capacity dropped by more than 50 percent, a nation-leading decline, according to a report last year from the Illinois Consortium on Drug Policy at Roosevelt University.

State officials think the proposal would work in concert with new state laws aimed at combating opioid addiction to reserve that trend. Among the services that would be available to Medicaid recipients with substance abuse problems are short-term residential treatment, case management, withdrawal management and recovery coaching.

Law enforcement officials who attended Thursday’s hearing praised the proposal.

Christian County Sheriff Bruce Kettelkamp, a former Illinois State Police narcotics officer, said he never expected to see a heroin problem in his rural community, but there have been three heroin overdose deaths in the county so far this year.

Christian County has active mental health and drug courts, Kettelkamp said, but participants often have to spend time in the local jail until space becomes available in treatment programs. The area also lacks housing and jobs for people with mental illness and addiction, he said.

“I hope and pray that this will help us,” Kettelkamp said. “It sounds like it will.”

Sara Howe, CEO of the Illinois Association for Behavioral Health, said the proposal is strong overall.

“It’s fantastic to see a vision that is articulated by the state for behavioral health and so many people behind it in all different facets supporting that,” Howe said.

But there is room for improvement, she said.

For example, Howe said her organization would like to see supportive housing services made available to people with substance abuse problems as well as those with mental illness.

Felicia Norwood, director of the Illinois Department of Healthcare and Family Services, said it will take some time for the state to implement the changes if and when the federal government approves the waiver. Pending federal approval, the changes would be effective July 1.

Part of the process will be taking stock of existing services throughout the state and identifying where there are gaps, Norwood said.

The idea is a tailor services to the needs of local communities.

“We’re not asking for kind of a one-size-fits-all (approach) because what’s going to work in Bloomington won’t work somewhere else,” Norwood said, “and we want to take into consideration the local service delivery system that’s already in place.”

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