1115 Behavioral Health Waiver

What’s new?

  • On May 7, Illinois Department of Healthcare and Family Services received notice that parts of their 1115 Behavioral Health waiver were approved to be effective July 1, 2018.
  • Click on the link for each of the waiver pilots or state plan amendment programs to get more information as it is available from the State of Illinois.
  • The waiver included several pilots to begin in demonstration year 1 including –
    • Short-term residential and hospital inpatient treatment for individuals with substance use disorder (SUD) in institutions for mental diseases, scheduled for a statewide implementation and excluding the cost of room and board;
    • Clinically managed withdrawal management services for residential treatment facilities and based on geographic eligibility;
    • SUD case management, based on geographic eligibility;
    • Peer recovery support services, based on geographic eligibility;
    • Crisis intervention services, based on recipient eligibility;
    • Evidence-based home visiting services for mothers up to 60 days post-partum and children up to five years; and
    • Intensive in-home services, based on recipient eligibility.
  • Housing support and employment services pilots are scheduled for demonstration year 2, and respite services for demonstration year 3.
  • There were also affiliated State Plan Amendments submitted and approved including – Mobile Crisis Response, Crisis Stabilization, universal assessment tool and integrated health homes (IHHs).  The first three are scheduled for summer 2018 while IHH is scheduled for October 2018.

What’s the issue?

  • 1115 Waivers are one of the key tools that states use in their role as “laboratories of democracy.”
  • These contracts give states the freedom to use their Medicaid dollars in ways that would not normally be allowed under existing Medicaid rules.
  • As long as states do not exceed what they would normally spend for their Medicaid program, CMS can provide an 1115 Waiver to allow them to pilot and test initiatives that show promise in improving the way that Medicaid works.
  • In 2016, Illinois solicited input from over 2,000 stakeholders in order to create an 1115 Waiver addressing the behavioral health system in the state.
  • Currently, the 25 percent of Illinois Medicaid beneficiaries with behavioral health issues account for 56 percent of all Medicaid spending.

Why does it matter?

  • Revamping the delivery of behavioral health in Illinois has the potential to create significant savings, while at the same time addressing pressing social problems such as the opioid epidemic.
  • The recent budget stalemate in Illinois has had significant impact on community behavioral health providers and the waiver is one way of rebuilding care in the community.
  • The waiver would also help alleviate some of the stress on the system due to a shortage of mental health professionals in the state.
  • Illinois needs a more coordinated, efficient, outcomes-based behavioral health system that reaches people with the right kind of care, at the right time.
  • The waiver is focused on integrating physical and behavioral health, moving care from institutions to community-based settings and supporting the state’s journey to value-based care. Key activities and services funded under the proposed 5-year waiver include:
    • Greater access to supportive services, such as housing, employment and re-entry program for justice-involved individuals
    • Redesign of the substance use disorder service continuum
    • Optimization of mental health service continuum
    • Additional benefits for children and youth with significant mental health needs
    • Workforce development

What is the AMITA Health perspective?

  • AMITA Health sees first-hand behavioral health needs. AMITA Health is the largest provider of behavioral health services in the state. Our emergency departments have seen an increase in individuals needing behavioral health care as a result of the decreased availability of community mental health services.
  • Physical and mental health care must be coordinated. Treatment of physical and mental health in one setting is important and the current reimbursement structure does not support care delivery in this way. Medicaid beneficiaries who need mental health services can receive them in a community setting rather than a more costly hospital setting.
  • Workforce development is critical for the future of behavioral health care. AMITA Health supports workforce development initiatives such as loan forgiveness that would address the state’s shortage of mental health professionals.
  • Telehealth can effectively meet mental health demands. We also support increased support for telehealth through the waiver as a means of expanding the capacity of our current mental health providers.

AMITA Health Resources

Materials developed by AMITA Health to help you understand, communicate and engage on issues important to health care and our ministry.

Illinois’ Behavioral Health Transformation – 1115 Overview

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External Resources

Information from third-party organizations that can be resources for you to continue to learn about the issues at hand.

1115 Behavioral Health Waiver Analysis

IHA Analysis of 2017 Medicaid Behavioral health Delivery and Payment System Reform

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2017 State of Illinois CMS Approval Letter for 1115 Behavioral Health Waiver

2017 State of Illinois CMS Approval Letter for 1115 Behavioral Health Waiver

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Featured News

Featured news includes articles from multiple viewpoints and is designed to keep you abreast of the current debate around this issue. This information should not be construed as our point of view.

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