1. National Association of Medicaid Director’s Fall Conference
Behavioral Health Integration in the Medicaid Program
Blake Fulenwider
Deputy Commissioner
Chief, Medical Assistance Plans
November 14, 2018

2. FY 2018 Medicaid Expenditures and Enrollment by Program
ABD is 25% of the population and 59% of the cost
LIM is 69% of the population and 39% of the cost
PCK is 6% of the population and 2% of the cost
Note: Includes CHIP

3. FY 2018 Medicaid Expenditures and Enrollment by Delivery System
CMO members are 66% of the population and 37% of the cost
FFS members are 34% of the population and 63% of the cost
Note: Includes CHIP

4. Medicaid Rehab Option FY 2018 Expenditures and Top 10 Services
CMO members are 28% of the Medicaid Rehab Option cost
FFS members are 72% of the Medicaid Rehab Option cost

5. Medicaid Rehab Option Integration Opportunities in BH Services
Physician/Psychiatric Treatment allows:
Evaluation and assessment of physiological phenomena (including comorbidity between behavioral and physical health care issues).
Nursing Assessment and Care allows:
Observation, monitoring and care for the physical, nutritional, behavioral health and related psychosocial issues, problems or crises.
Assessment and monitoring medical and other health issues that are either directly related to the mental health and substance related disorder, or to the treatment of the disorder (e.g. diabetes, blood pressure issues, substance withdrawal symptoms, seizures, etc.)
Assertive Community Treatment (ACT) allows:
Gaining access to necessary internal and external rehabilitative, medical and other services.
Assistance to develop both mental illness and physical health symptom monitoring and illness self-management skills.
A physical health management plan to be required as a programmatic goal
The Majority of Behavioral Health-targeted Services are covered under the State Plan via the Medicaid Rehabilitation Option (MRO).

6. Medicaid Rehab Option Targeted Integration Services
Clinical consultation, specifically designed to promote communication and coordination of health with other treating medical practitioners, allows:
Coordination or revision of a treatment plan; and
Understanding the complexities of co-occurring medical conditions on the individual’s behavioral health recovery plan (e.g. kidney failure, diabetes, blood pressure, etc.)
Review of the individual’s progress for the purposes of collaborative treatment outcomes.
Peer Support Whole Health and Wellness:
Included under the Peer Support umbrella in the MRO and added as a result of prevention being added in the ACA to the Rehab definition.
Provides coaching interventions to individuals to:
Promote healthy lifestyles and to reduce identifiable physical health risks.
Increase healthy behaviors intended to prevent the onset of disease or lessen the impact of existing chronic health conditions
Teach more effective management techniques that focus on the individual’s self-management and decision making about healthy choices.

7. Peer Support Whole Health and Wellness Highlights and Outcomes
Provided by Certified Peer Specialists (CPS) who have ad hoc specialized health training.
Health training curriculum jointly designed between HHS agency partners: HRSA and SAMHSA.
Must have an identified nurse supporter.
Participants have shown significant improvement in:
Patient activation than those in usual care and in rates of having one or more primary care visit intervention.
Advantages were observed for physical health related quality of life, physical activity, and medication adherence.
Decrease in cardiometabolic risk factors

8. Opportunities for Integration within Managed Care
CareSource has interdisciplinary field teams (similar to the DBHDD ACT model).
Teams include both medical and behavioral health specialists
Identify unique needs of members
Improve coordination, treatment compliance, and communication between their providers.
Integration of behavioral health staff in the staffing model allows for increased opportunities to correlate physical and behavioral needs of members.
25% of care coordination staff have BH experience
Provide mandatory mental health first aid class to all member- facing staff.

9. Strategies to address gaps and barriers
Continued partnership with DBHDD, the state’s behavioral health authority.
Out of clinic service delivery, allowable under the MRO and enables many services to be provided in other medical settings such as FQHCs, medical practices, etc.
Limited usage, there hasn’t been an extensive adoption of this practice.
Telemedicine
Broad array of allowable services.
Every Community Service Board (CSB) in the state has telemedicine capacity.