By Athena Mandros
Yesterday, we took a look at the 16 states that were first to implement Medicaid health home adopters (see It’s 2015! Where Are We With Health Homes?). But where will we see Medicaid health homes launch next? So far, there are eight additional states – Arkansas, California, Connecticut, Illinois, Massachusetts, Minnesota, Oklahoma, and Virginia – that have started the design and approval process for bringing health homes to their Medicaid plans. But, unlike Medicaid expansion, there is no hurry for states to implement health homes, as the enhanced Federal Medical Assistance Percentages (FMAP) – 90% for eight quarters – has no expiration date (see Health Homes (Section 2703) Frequently Asked Questions). Therefore, we can expect to see states slowly, but surely, begin to adopt health homes as a model of care coordination. What does that landscape look like?
Arkansas, Connecticut and Oklahoma – Arkansas and Connecticut have submitted health home SPAs to the Centers for Medicare and Medicaid (CMS) and are awaiting approval to begin implementation. Oklahoma just recently had its health home model approved on February 10, 2015. The state began the actual implementation of the health homes in January. Interestingly, all three of these states do not operate managed care programs – Oklahoma and Arkansas operate primary care case management programs (PCCMs), and Connecticut operates a managed FFS model that utilizes Administrative Service Organizations (ASOs). It is possible that the lack of managed care has prompted these states to find another way to curb costs.
|
Key Features Of States With Proposed State Plan Amendments |
||||
|
State |
Proposed Start Date |
Populations Included |
Lead Entity |
Payment Model |
| Oklahoma | Approved February 10, 2015 | Individuals with SMI and two or more functional impairments, and psychotic symptom or experiencing inference with skills (approximately 13,800 individuals in 2015) | Community Mental Health Centers or Behavioral Health Providers | Three levels of PMPM Payment: 1. Low to medium care (urban) $146.76 (rural); 2. High Intensity/PACT care coordination: $453.96 (urban and rural); 3. Outreach and engagement: $53.98 (urban and rural) |
| Connecticut | Early 2015 | Individuals with SMI and more than $10,000 in Medicaid claims a year (approximately 10,500 individuals) | 1. Behavioral Health ASO is responsible for provider credentialing and claims adjudication; 2. Services provided by Local Mental Health Authorities and contracted providers | None |
| Arkansas | July 1, 2015 | Individuals with Serious Mental Illness | Behavioral Health Providers | 1. Tier 2 PMPM (Children) – $100 PMPM; 2. Tier 2 PMPM (Adult) – $100 PMPM; 3. Tier 3 PMPM (Children) – $200 PMPM; 4. Tier 3 PMPM (Adult) – $200 PMPM |
California, Illinois and Minnesota – California and Illinois have indicated that they are interested in submitting a health home waiver to CMS and have drafted concept papers that outline their plans (see California Planning For Health Homes For Patients With Complex Needs In 2015 and Illinois Health Homes Initiative Concept Paper). Minnesota expressed interest in implementing health homes since 2013, however the state’s adoption has been slow moving. A January 2015 presentation suggests that the state is ready to begin implementation in early 2015, but there is no mention or documentation of a completed SPA (see Minnesota Behavioral Health Home Overview). More interestingly, Illinois is the first state to propose reallocating money already given to the state’s managed care entities to provide care coordination for the whole population, to the health home population. The state will also provide an additional fee for individuals who need more intensive services. This proposal may affect the state’s ability to receive the enhanced FMAP, as they are reallocating money already provided for all Medicaid enrollees and taking away the availability of care coordination for their population. My guess is the state is proposing to reallocate the money from existing sources to prepare for when the enhanced FMAP ends and the state begins receiving their regular FMAP for the services provided.
|
Key Features Of States With Concept Papers |
||||
|
State |
Proposed Start Date |
Populations Included |
Lead Entity |
Payment Model |
| California | Submit SPA in August 20152. Implementation in January 2016 | Individuals with chronic condition and at-risk for another, two chronic conditions, or an SMI | Managed care plans will act as lead entity | None, but payment will be included in the managed care plan’s capitation rate |
| Illinois | Implementation date of October 1, 2015 | Not specific to mental health; individuals with one chronic condition and at risk for another or two chronic conditions | The state’s managed care entities (ACEs, CCEs, MCOs, MCCNs) will act as lead entities | 1. MCOs/MCCNs: Reallocate care coordination dollars included in the MCO’s capitation rate and provide additional monies for high-risk enrollees; 2. ACEs/CCEs: Reallocate care coordination fee to health home population and additional monies for high risk enrollees; 3. All organizations will be subject to a quality withhold |
| Minnesota | Early 2015 | Individuals with SMI (approximately 109,000 individuals) | Community Mental Health Centers, Pediatric Clinics, and fully integrated primary care clinics will serve as lead entities | Proposed two tier per member per month payment structure |
Massachusetts and Virginia – These two states have expressed recent interest in developing a health home model, although the actual implementation is much more tenuous. In Massachusetts, the Department of Health and Human Services announced in a November 2014 presentation for stakeholders that it would be pursuing health homes for individuals with SMI, with a focus on its One Care population. One Care is the state’s dual demonstration program for individuals ages 21-64 (see One Care: MassHealth Plus Medicare). In Virginia, Governor Terry McAuliffe released a document entitled Healthy Virginia, which detailed the state’s plan to submit a SPA to CMS to implement health home homes and expand limited Medicaid benefits to the SMI population. Thus far the state has expanded benefits to the SMI population through a 1115 waiver, but no information has been released on the health home SPA (see Virginia Medicaid To Move To Health Homes & Medicaid Expansion For SMI).
As states pursue new and innovative care coordination methods, we will continue to follow them here at OPEN MINDS. If you’re state is on the list of “soon to come” health homes, and you want more information on how to prepare, check out these resources in the OPEN MINDS Industry Library – Making Health Homes Sustainable – A Provider Perspective, Are Health Homes Working? The Payer Perspective, and A Health Home Update – Health Homes Go Private.
