Association of Indiana Counties Annual Conference September 27th, 2017 Opioids and Mental Health – There’s more to the crisis than just needle exchanges Association of Indiana Counties Annual Conference September 27th, 2017 Matt Brooks, President & CEO Indiana Council of Community Mental Health Centers

Background on Substance Use Treatment in Indiana The funding of addiction treatment services in Indiana has been a challenging issue for many years. Historically, substance use treatment providers received limited government funding support in Indiana, with the majority of funding specifically dedicated to addictions provided through the Substance Abuse and Mental Health Services Administration (SAMHSA) in the form of block grant funding. The funding is administered through the FSSA Division of Mental Health and Addiction (DMHA). As a result, addiction providers did not develop significant investment into addiction treatment, as reimbursement models did not support the high cost of substance use treatment for areas such as: intensive case management, residential housing, detox services, and crisis stabilization. In addition, because reimbursement models did not support the cost of services, there was limited human capital investment in college curriculums and training programs designed to educate and support the hiring of addiction treatment professionals. In 2009, the Indiana General Assembly established Licensed Clinical Addiction Counselors (LCACs) as a professional license, however, a limited number of individuals have pursued attainment of the license, as there were limited incentives for providers, such as CMHCs, to hire due to reimbursement rate challenges and the ability to bill for addiction services under Medicaid within the authorized Scope of Practice.

Impact of HIP 2.0 on Addiction Treatment Following the passage of the Mental Health Parity Act, access to addiction treatment became mandatory as a mental health benefit, however commercial insurance policies provide limited coverage, primarily for one on one therapy sessions, with a limited number of visits annually. While the required “Essential Health Benefits” contained within the Affordable Care Act (ACA), i.e. Obamacare, includes mental health and substance use treatment, the level of treatment provided under the program is often not sufficient to meet the needs of an individual suffering from a substance use disorder. Until the passage of the Healthy Indiana Plan (HIP) 2.0, addiction treatment was not covered under the Medicaid program in Indiana unless an individual was dually diagnosed with both a mental health disorder and a chronic substance use disorder. Prior to HIP 2.0, Indiana had very strict Medicaid eligibility requirements and many health consumers, such as individuals involved in the criminal justice system, had no access to addiction treatment. With the passage of HIP 2.0, qualifying individuals, regardless of health condition, are eligible for coverage as long as they are 138% or below of the Federal Poverty Level.

Impact of HIP 2.0 on Addiction Treatment As a result, individuals who historically had no access to addiction treatment, have the opportunity to access treatment through HIP 2.0 Individuals determined to be “Medically Frail”, under the federal definition for Chronic Substance Use Disorder (SUD) have improved access to Medicaid based treatment through the Medicaid Rehabilitation Option (MRO) program. In addition, in 2015, the Indiana General Assembly established a process for individuals incarcerated in the criminal justice system to have access to Medicaid treatment upon release from the IDOC or county jails, enhancing the ability to obtain immediate treatment, including psychotropic medications. The Indiana General Assembly authorized $70 million in new funds over the last two biennium budgets in support of addiction treatment for qualifying felons under the “Recovery Works” program. This funding is designed as an alternative to incarceration in response to HEA 1006-2013 and to reduce high recidivism rates. In spite of these positive trends, much more work is needed to respond to the opioid crisis facing Indiana.

County Funding for Addiction Treatment County Government funding support for addiction treatment in Indiana has been limited through the years. County support for mental health and substance use treatment is primarily provided to the community mental health center system and used as match to support the federal Medicaid program. In 2017, counties provided approximately $36.5 million (approx. $400,000/county) for both mental health and substance use treatment in Indiana, which accounts for 6% of total CMHC revenue.

Addiction issues still facing Indiana The community mental health center system has been challenged to respond to the increased demand for addiction services, as there are a limited number of qualified professionals licensed to provide services based on Medicaid billing requirements. Proposed federal legislation related to repealing Obamacare would place significant burdens on states to continue to provide addiction treatment under the designed block grant program. Reimbursement rates for services such as Addiction Recovery Residences and Addiction Recovery Support Teams are not currently available under Medicaid, which limits the ability to provide services to those with the greatest need. Policymakers and elected officials who seek to criminalize addiction versus treating as an addictive disorder continue to promote funding for criminal justice over treatment, leading to increased crime, recidivism, and an inability to respond to the ever changing demand of drug abusers. Coordinated efforts at enhancing the number of addiction providers, combined with enhanced reimbursement rates for addiction treatment, are required to improve the current opioid crisis in Indiana.

QUESTIONS? Matt Brooks, CEO Indiana Council of Community Mental Health Centers, Inc. mbrooks@indianacouncil.org 317-684-3684 www.indianacouncil.org