Creating Quality Coverage to Support Sustainable Recovery Families USA 2014 Health Action Conference Mental Health and Substance Use Disorder Care in a Reformed World January 25 th Washington, DC

Need for Robust SUD/MH Services in Medicaid Substance Use Disorders Affect 22% of Those in Medical Settings (NSDUH, 2005) Among young adults 18 – 34, between 10% - 20% have SUD; about 90% do not receive care! (NSDUH, 2005) About 20% of Medicaid hospital costs are associated with people with SUD Patients with Co-Occurring MH/SUD are most likely to use ED services repeatedly and at almost twice the rate of patients with the other conditions (HCUP, 2009)

ACA Opportunities to Improve Medicaid SUD/MH Benefit Medicaid expansion includes Essential Benefit Plan which must cover people with mental illness and substance use disorders Adding health homes for SUD/MH Meeting parity requirements in managed care

Components of a Robust Benefit  Public Health Approach: Screening, Early Intervention and Re- Intervention  Peer-Based Recovery Support  Recovery Outcomes  General Health Providers (primary care physician practices/FQHCs/Rural Health Centers ) promote BH engagement, early evaluation & assessment, services/supports, and referral  General Medical/Behavioral Health Consultation  Medical/Health/Wellness Education and related Skills Building (including access for families and other natural supporters)  Range of Crisis Services, including detox  Outpatient/Intensive Outpatient  In-patient and residential  Recovery residence services  Substance Use Disorder Medication Assisted Therapies  Medication Management  Care Coordination

The Likelihood of Sustaining Abstinence Another Year Grows Over Time 36% 66% 86% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 1 to 12 months1 to 3 years4 to 7 years Duration of Abstinence % Sustaining Abstinence Another Year. After 1 to 3 years of abstinence, fewer than half return to AOD use After about 5 years of abstinence, only about 14% resume AOD use Dennis, Foss & Scott (2007). An eight-year perspective on the relationship between the duration of abstinence and other aspects of recovery. Evaluation Review, 31(6), Over a third of people with less than a year of abstinence will sustain it another year

Creating Path to Sustainable Recovery Our Proposition: Partner with SUD and MH organizations, especially recovery organizations Build consensus about SUD to be seen and treated as a chronic condition Make the case that robust behavioral health benefits can save costs in the health and criminal justice systems Offer expertise to state Medicaid officials Keep advocating

What Happened in Georgia? Nat’l leader in Peer Support – Georgia Mental Health Consumer Network; Whole Health and Wellness/Addiction Peer Support as a Medicaid Billable Service Medicaid leadership willingness to engage in new ways and develop managed care approach Strong advocacy led to M’Caid authority being invitational Fiscally conservative leadership who want to spend less on corrections Growing recognition of SUDs role in state costs We are now invited to the table in a variety of settings

How to Connect with SUD/MH Advocates Be invitational! Recovery Advocates are in each state Statewide BH Provider Organizations Community Corrections Recovery Community Organizations Voice of the lived addiction recovery experience should be at every table Express that addiction and mental illness are public health issues and a public health approach should be taken to address them

Dennis, M.L., Foss, M.A., & Scott, C.K (2007). An eight-year perspective on the relationship between the duration of abstinence and other aspects of recovery. Evaluation Review, 31(6), Appendix What does recovery look like on average? Duration of Abstinence 1-12 Months 1-3 Years 4-7 Years More social and spiritual support Better mental health Housing and living situations continue to improve Dramatic rise in employment and income Dramatic drop in people living below the poverty line Virtual elimination of illegal activity and illegal income Better housing and living situations Increasing employment and income More clean and sober friends Less illegal activity and incarceration Less homelessness, violence and victimization Less use by others at home, work and by social peers