Transcript csh-sdhfconference-hhp-wpc-dmc

Health Homes, the
Waiver, and Drugs,
Oh My!
Sharon Rapport, Corporation for
Supportive Housing
Our Mission
Advancing housing solutions that:
Improve lives of
vulnerable
people
Maximize public
resources
Build strong,
healthy
communities
Federal Medicaid Agency Clarification
Around Supportive Housing
Informational
Bulletin to States:
June 2015
States Can Design Medicaid to
Pay for Housing-Related
Activities & Services
Housing transition services,
Tenancy support services,
One-time costs of housing.



х Medicaid Can’t Pay for
Long-Term Housing
Costs
Section 2703 of the ACA: “Health Homes for Enrollees with
Chronic Conditions”
States can
apply for
optional
Medicaid
benefit.
90%
federal
funding for
2 years,
then
FMAP rate
To
coordinate
&
integrate
care
for
Medicaid benes
with—
-2 chronic
conditions
-1 condition,
risk of 2nd
1 serious MI
Health Homes = Virtual “Home” for Providing
Services to People with Complex Conditions
CA Assembly Bill 361 (Mitchell):
 Authorized DHCS to create a new Medi-Cal Health Home benefit
for Medi-Cal beneficiaries.
 Required DHCS to make benefit meaningful for beneficiaries who
are CHRONICALLY HOMELESS.
Health Home Program Services Required by Affordable Care Act
COMPREHENSIVE
CARE
CARE COORDINATION
MANAGEMENT
HEALTH
PROMOTION
COMPREHENSIVE
TRANSITIONAL
CARE
COMMUNITY INDIVIDUAL
and SOCIAL and FAMILY
SERVICES
SUPPORTS
Eligibility of Health Home Beneficiaries:
Many Will Be Homeless
Two chronic
conditions:
• Asthma
• COPD
• Diabetes
• TBI
• Chronic/Congestive Heart
Failure
• CAD
• Chronic Liver
Disease
• Dementia
• SUD
6
Hypertension One of the
& one of the Following:
following:
• Major
• COPD
• Diabetes
• Coronary
Artery Disease
• Chronic or
Congestive
Heart Failure
Depressive
Disorders
• Bipolar
Disorder
• Psychotic
Disorders
(including
Schizophrenia)
Asthma &
risk of:
•
•
•
•
Diabetes
SUD
Depression
Obesity
Acuity: Predictive level of 3+, 1 IPT stay, 3 ED visits,
chronic homelessness
CA Health Homes Program (HHP) County Roll-Out:
2017-2019
Group 1
Group 2
HHP starting
for members with Chronic
Physical/SUD
HHP starting
for members with Chronic
Physical/SUD
July 1, 2017
Jan 1, 2018
for members with SMI
for all other eligible
members
Jan 1, 2018
Del Norte
Humboldt
Lake
Marin
Mendocino
Napa
San Francisco
Shasta
Solano
Sonoma
Yolo
July 1, 2018
Imperial
Lassen
Merced
Monterey
Orange
Riverside
San Bernardino
San Mateo
Santa Clara
Santa Cruz
Siskiyou
Ventura
7
Group 3
HHP starting
for members with Chronic
Physical/SUD
July 1, 2018
for all other eligible
members
Jan 1, 2019
Alameda
Fresno
Kern
Los Angeles
Sacramento
San Diego
Tulare
California’s Whole Person Care Pilot:
“The Waiver”
1115 Waivers:
Demonstrations giving
states additional flexibility
to design and improve their
Medicaid programs and to
evaluate policy approaches,
such as providing services
not typically covered.
Typically last 5 years.
Whole Person Care
Pilots
Infrastructure &
interventions that integrate
health, behavioral health,
social services among high
users of multiple systems.
California’s Whole Person Care Pilot:
“The Waiver”
Federal:
$300M
Per Year
Counties
Collaborate &
Share Data
Identify
Populations
Coordinate Care
California’s 1115 Medicaid Waiver:
Whole Person Care Pilots
Potential Populations:
Frequent Jail or Hospital Users, People Experiencing Homelessness/
People at Risk of Homelessness Upon Exit from an Institution
High Users of
Multiple
Systems,
Poor Outcomes
Homeless
Beneficiaries
Strategies: Increase Access to Housing &
Supportive Services
Whole Person Care Housing Costs
 WPC Cannot Fund
Long-Term Rent
 WPC Can Fund:
 First Month’s Rent or
Security Deposit
 Home Modifications
 Interim Housing/Respite/
Recuperative Care
 Housing Pool
Housing Pools
• Long-Term
Housing
Costs
Private $
MCO
“Savings”
County or
State
General
Funds
Other
NonFederal $
• Long-Term
Housing
Costs
Whole Person Care Pilots, Health Home
Benefit: Two Programs, Similar Services
OUTREACH &
ENGAGEMENT
Outreach
Assessments
Landlord &
Tenant Education
Tenant Coaching
Agency
Collaboration
HOUSING TRANSITION TENANCY SUSTAINING
SERVICES
SERVICES
Assessment of
Intervening in
Housing Need
Behaviors
Jeopardizing
Housing Support
Housing
Plan
Housing Crisis
Plan
Housing
Application
Assistance,
Housing Search,
Securing
Documentation
Assistance With
Move-In
Educating Tenants
& Landlords
Help Resolving
Disputes
Training on Lease
Compliance
WPC ONLY
Housing
Pools
Partnerships,
Data Sharing
Creating Single
Point of Entry
Modifications to
Unit
Overlap/Differences: WPC vs. HHP
Whole Person Care
Pilots
• Eligibility: High
Users of Multiple
Systems
• County-Run
• Very Flexible:
• Create
Partnerships
• Create Data
Sharing
Systems
• One-time or
Short-term
Housing Costs
• 5 Years
• Homeless
Beneficiaries
Called Out
• Can Fund
Housing
Navigator:
“Tenancy
Transition” &
“Tenancy
Sustaining”
Services
• Team-Based
Approach
Health Home
Benefit
• Eligibility:
Beneficiaries with
Complex
Conditions,
Meeting Acuity
• Entitlement
• Administered by
Managed Care
Organizations
• Not as Flexible
• No Housing Costs
(Only Services)
• Ongoing
(potentially)
Drug Medi-Cal Organized Delivery
System Waiver
Improve Access to SUD Evidence-Based
Treatment
 Counties Can Opt In to Provide
Additional Benefits. . .
. . . Or the County Residents Keep
Existing Benefits
 Counties Set Own Rates,
with State Approval, to
Attract More Providers
Drug Medi-Cal Organized Delivery
System Waiver: Benefits
Benefits Counties Will
Residents of Counties
Offer if Opt In
Opting Out
1. Outpatient Drug-Free
2. Narcotic Replacement
Therapy (methadone)
3. Intensive Outpatient
Counseling
4. Naltrexone
5. Residential Treatment
(perinatal only)
6. Elective Inpatient
Detoxification
1. Early Intervention
2. Outpatient Services
3. Residential Services (90 days)
4. Narcotic Treatment Program
5. Withdrawal Management
6. Recovery Services
7. Case Management
8. Physician Consultation
9. Partial Hospitalization
(optional)
10. Other Medication Assisted Tx
(optional)
Drug Medi-Cal Organized Delivery System
Waiver: Evidence-Based Treatment
ASAM
(American
Society of
Addiction
Medicine)
criteria guide
referrals &
treatment
necessary
Drug Medi-Cal Organized Delivery
System Waiver: Case Management
Coordination of
Treatment
• Must be
Medically
Necessary
• Can Use to
Manage SUD
Care, Advocate
with Health
Professionals
• Coordinate with
Primary/Mental
Health
Treatment/Social
Services
Flexibility
• Can Offer in the
Community
• By Licensed
Staff or AOD
Counselor
Restrictions
• Provider Must be
Connected to a
Certified
Treatment
Facility
• Must be Offered
in Relation to
Treatment
• County Must
Enter into MOU
with Medi-Cal
Managed Care
Plan
Timelines For Drug Medi-Cal Organized
Delivery System
County
Implementation
Plans
Approval by DHCS
(14 submitted plans)
Phase 1:
Bay Area
(7 plans approved)
Approved by CMS
Phase 2:
Southern CA
Phase 3:
(no current draft
for San Diego)
Central
Valley
Phase 4:
Northern
CA
Phase 5:
Tribal Areas
Drug Medi-Cal Organized Delivery
System Waiver
Ramifications for Homeless
Beneficiaries
Free Up Flexible Substance Abuse
Prevention & Control Dollars
-Interim Housing, Services
Enhance Health Home/Whole Person Care
Case Management Services
Greater Access to Substance Use Disorder
Treatment, More Providers, County Must
Ensure Access (or cover out of network).
Challenges to New Medi-Cal
Opportunities
?
Administered
through Managed
Care: Medical
Model
Benefit/Services Not
Housing Based—
Scaling Up to Coincide
with Housing
Availability
Providers:
Restrictions on
Providers, Capacity
20
[email protected]
(323) 243-7424 (c)
(213) 623-4342, x18 (o)
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