Maryland Mental Hygiene Administration

June, 2013

Brian Hepburn, M.D., Executive Director Maryland Mental Health Administration

How does state and county level data about the uninsured and their service needs and potential uses help prepare for Medicaid expansion?

Maryland mental health carve out for uninsured and persons with Medicaid. Administered by ASO. Started 1997

Eligibility, authorizations, claims payment and data collection by ASO.

Good state and local information on Medicaid population and uninsured with SMI http://dhmh.maryland.gov/mha/SitePages/data.aspx .

Work with MA Administration on potential increase in population. They are projecting 200,000 increase through MA expansion and 40,000 increase based on “woodwork “effect.

Penetration for mental health services for MA adults is approximately 17% (see penetration chart)

How does state and county level data about the uninsured and their service needs and potential uses help you prepare for Medicaid expansion? continued

The question is whether the individuals will follow the pattern of persons previously in the Public Mental Health System (PMHS) or will they be different.

We are expecting an increase in young persons with significant substance use problems and mild to moderate mental health issues. This resembles the population that lost access to entitlements in the 90s.

This will put increased demand on providers able to provide both mental health and substance use services.

Maryland is increasing emphasis on integration of Mental health and substance use services at the funding and delivery level.

There is an increase in reimbursement rates to Medicare levels for all physicians including psychiatrists.

There is an increase emphasis in telemedicine to better reach professional shortage areas.

How does a likely Medicaid expansion affect the other resources you have for mental health, such as the SAMHSA block grant and state general revenue, in your state?

Recession resulted in increased MA eligibility (see chart). 50% increase in MA covered individuals between 2008 and 2012. Recession may have resulted in significant cut backs to uninsured populations as states struggled to control budgets.

Additional concern that state only funded services may be decreased as move ahead with Health Care Reform and Medicaid expansion.

This is of concern since not all services are covered by Medicaid but necessary for Recovery (ie Housing). Individuals not getting access to outpatient services end up using higher level services (ie emergency room and inpatient).

SAMHSA block grant helped fund services necessary for recovery of uninsured persons with SMI and of uninsured individuals with Substance use problems. The fear is that these funds will be cut due to the increased coverage by Medicaid. However, we are hopeful these funds will remain in order to help with the changing roles of states in moving towards Wellness, Prevention and Early intervention.

State general funds have been used for services not covered by Medicaid or for uninsured individuals. These are services necessary for recovery.

How will you conduct outreach and make eligibility decisions for these populations that may be harder to reach?

Homeless ID project. State funded project to assist people in getting birth

certificates and state IDs in order to facilitate getting entitlements. SOAR (SSI/SSDI Outreach, Access, and Recovery project)-federal initiative

to improve access to SSI and SSDI for individuals who are homeless or at risk of homelessness and diagnosed with a mental illness or co-occuring disorder. Administered by Social Security Administration. http://www.ssa.gov/homelessness/collaborations.htm

PATH (Project for Assistance in Transition from Homelessness)-Outreach and case management to reach persons who are homeless and to get them into services. http://pathprogram.samhsa.gov/

Focusing on individuals in jails, prison or state hospitals. Predicting who else might be eligible and what this population will look like

As indicated previously, we are expecting an increase in young persons with significant substance use problems and mild to moderate mental health issues. This resembles the population that lost access to entitlements in the 90s.

What lessons have you learned from using or not using data in the past to inform decisions?

Claims data in the PMHS has been very helpful. Used for showing trends in growth of persons covered, costs, penetration, average cost per person, individual service costs, utilization trends, MA/MASF and uninsured costs. However claims are used to get paid and clinical data may not be accurate and may not help to determine outcomes. http://dhmh.maryland.gov/mha/SitePages/data.aspx

Data is helpful to tell the story of the system developing and evolving. It is useful to help policy makers, budget analysts, legislators and stakeholders understand the importance of behavioral health services.

Authorization data is used in Maryland in the Outcomes Measurement System (see following slides). http://maryland.valueoptions.com/services/OMS_Welcome.html