CORONAVIRUS (COVID-19) RESOURCE CENTER Read More
Add To Favorites

Hopes for savings with McAuliffe Medicaid mental health proposal

Daily Press (Newport News, VA) - 9/10/2014

Sept. 10--One of the key things state officials will be watching, if they get a federal OK to add roughly 20,000 people with serious mental illnesses to the Medicaid rolls, is whether covering relatively inexpensive primary care doctors' services and mental health care can really save big money by avoiding costly hospitalizations.

Those 20,000 could be the biggest group of people newly eligible for taxpayer-funded health care -- limited in their case -- in Gov. Terry McAuliffe's 10-step program to carve away at the number of uninsured Virginians after the General Assembly declined to expand Medicaid.

"They are the neediest of the needy," said Christina Nuckols, communications adviser to Secretary of Health and Human Resources Bill Hazel, who drafted the 10-point program.

The 20,000 are not now covered by Medicaid, which means whatever mental health care they do get comes entirely at the expense of state and local taxpayers, through the money Virginia and its cities and counties send to Community Services Boards, or that pay for people in jail and state hospitals.

McAuliffe's proposal would cover medical care from primary care doctors, mental health treatment and medications, but not in-patient hospital or emergency room care.

The theory behind it is basically the theory behind the Affordable Care Act itself -- that when people have the financial means to get care before they get too sick, that saves the rest of a community the cost of high-priced, emergency-room care, Nuckols said.

Looking at whether that happens will be a key part of the evaluation that the federal Centers for Medicare and Medicaid Services requires when it allows states to experiment with Medicaid, as Virginia would be doing here by providing only a limited medical care benefit.

The state has already started talking with federal Medicaid officials about the idea, and is moving the effort to cover the 20,000 on a fast track, by scheduling two public hearings this month, Nuckols said. Those hearings, plus a federal hearing and an extensive application process are all required before federal officials act on McAuliffe's proposal.

Virginia currently says disabled people -- including people with mental illness -- are eligible for Medicaid if their income is less than 80 percent of the federal poverty level. McAuliffe's proposal would mean people with mental illness with incomes up to 100 percent of the federal poverty line could get the limited benefit -- basically, individuals with incomes between $9,360 and $11,670 a year.

The cost of their limited benefit would be split 50-50 with the federal government, and accounts for the bulk of the roughly $40 million a year in state funds required for McAuliffe's 10-point program. McAuliffe spokesman Brian Coy said those funds are already available in the budget to be tapped.

Virginia hasn't been as active as other states in using special waivers from the Centers for Medicare and Medicaid Services or specialized Affordable Care Act programs to reach people who aren't insured.

Its approach with the limited medical benefit may be unique.

Illinois is currently using a waiver to use Medicaid to pay only for mental health care for people who aren't otherwise eligible for full Medicaid benefits. Montana hopes to win federal approval to provide basic Medicaid coverage, including all the usual medical benefits, to cover about 2,000 people with specific mental illnesses who can get about $400 a month worth of mental health medication and therapy through a state program.

McAuliffe's 10-point program also calls for Virginia to follow the lead of 26 other states that have tapped, or that have asked to tap Affordable Care Act funds, to set up new "health home" programs -- a kind of coordinated care that in Virginia's task will target about 13,000 people with mental illness in southwest Virginia. The Affordable Care Act says the federal government will cover 90 percent of the cost of such programs.

McAuliffe also has high hopes from one fairly obscure part of his 10 points -- the joint application by the state and the Virginia Center for Health Innovation for a $2.6 million grant from the Centers for Medicare and Medicaid Services to explore other new ways of delivering care to the uninsured. Nuckols said that grant could open the door to other federal grants that could help provide health care coverage to other groups of uninsured Virginians.

McAuliffe announced the 10-point effort in response to the General Assembly's rejection of proposals to tap some $2 billion a year in Affordable Care Act funds to expand Medicaid coverage to all Virginians living in households with incomes below 138 percent of the federal poverty line. More than 370,000 Virginians in that position currently do not have any health coverage.

Ress can be reached by phone at 757-247-4535.

___

(c)2014 the Daily Press (Newport News, Va.)

Visit the Daily Press (Newport News, Va.) at www.dailypress.com

Distributed by MCT Information Services