BOISE – Before Monday, a Medicaid patient receiving inpatient substance abuse treatment who needed to transition to outpatient therapy would have to contact multiple organizations and navigate several systems to make sure that happened.
As of Monday, Idaho’s fragmented behavioral health care system should be more holistic as the new Idaho Behavioral Health Plan officially went live. The plan means that Medicaid, and some non-Medicaid patients, will have their mental health and substance abuse treatment and health care all overseen by one managed care organization, Magellan Health.
“This is really transformative,” said Juliet Charron, Idaho Department of Health and Welfare deputy director of Medicaid.
Previously, Idaho’s behavioral health plan, which is overseen by a third-party managed care organization, only covered outpatient services for Medicaid services. Inpatient behavioral health services are only covered under Idaho Medicaid’s fee-for-service model.
The $1.2 billion, three-year contract is also meant to increase access to services.
Magellan is required to staff and deploy mobile crisis teams across the state who can provide services and support to someone in a crisis, Charron said. The planned youth residential psychiatric facilities are part of improving access, she said. The state’s first ever facility of this kind — the Idaho Youth Ranch Residential Center for Healing & Resilience in Caldwell — opened last August, but just began billing Medicaid through Magellan as of Monday. More of these facilities are slated to open in Nampa, Idaho Falls and Twin Falls.
Idaho, like many states, has a behavioral health workforce shortage. This affects all levels of care, from outpatient therapy, to acute crisis treatment, to everything in-between. Charron said the pandemic exacerbated the issue because providers burned out and stopped accepting Medicaid patients, and now the state is trying to work with Magellan to improve access to services by attracting providers to the state and encouraging existing physicians to provide more services.
Charron said there’s a focus on improving the “in-between” care, which is more intensive than therapy but less intense than residential psychiatric treatment, and is meant to prevent a crisis and the need for residential treatment.
An example of this is the state’s assertive community treatment, or ACT, program. The health department had been administering the services through state employees with expertise in psychiatry, nursing, social work, counseling and addiction services. But the state’s capacity to provide these services was limited, and so this has been transferred to the managed care organization.
Health department staff who had been providing ACT services transitioned to a new bureau in the division called the Center for Excellence and will coach and mentor private providers across the state.
Through the Center for Excellence, the department hopes to provide training and support to any providers who want to expand on the behavioral health services that they already offer.
There are going to be people in Idaho who are in too remote of an area to access what they need in their own community, Charron said. Transportation for medically necessary reasons is covered by Medicaid.
A care coordinator would likely take a role in finding transportation to get a participant to services. The health agency had previously provided some care coordination and case management, but just didn’t have enough staff to do so comprehensively, Charron said.
Individuals who need very high levels of care are automatically assigned a care coordinator to help connect patients to services, transition between levels of care, and make it to their appointments.
The single point of contact for all behavioral health services is also meant to help the provider, Charron said.
Providers’ concerns about the major transition largely centered on concern of whether they’ll be able to continue seeing their patients and if they will get paid for their services in a timely manner from Medicaid, Charron said.
Last summer, a task force of legislators looked into the possibility of moving all Medicaid services under a managed care organization, or MCO, with the goal of creating cost savings. A number of Idaho providers expressed concern with the idea, the Idaho Press reported.
“Early intervention in illness and the provision of quality preventive care upstream reduces those downstream health care costs that are substantial,” Dr. Kelly McGrath, of Clearwater Valley Health and St. Mary’s Health, told lawmakers at the time. “We often know the individual stories of what this looks like, and it cannot be achieved by remote managers in an MCO who are intent on maximizing their profits through the creation of administrative burdens and blanket rationing of care.”
McGrath was not speaking about the behavioral health plan, but about all services provided to Medicaid patients.
Charron said that behavioral health providers had already been working with the state’s previous MCO, Optum Health. She said the department and Magellan had been communicating with the providers ahead of time to address concerns.
“This has been in the works for several years now,” she said. “I think everyone knew what was coming.”
She said she’s overseen large contract transitions other times in her career, and she anticipates there will be hurdles, such getting used to the new system for providers to use to bill services to Medicaid for reimbursement.
“There are inevitably going to be some bumps in the road, and I know what’s very important is that, Magellan and the department, we are ready, we have mitigation plans in place and we’re ready to respond quickly,” she said.
Last year, the Legislature approved an increase of around 24 new full-time employees, many of which will go toward contract oversight. The department is taking a different approach to overseeing this contract than it has in the past, Charron said, and is hoping to improve how the agency ensures its vendors are performing as expected.
The new employees will evaluate more than “black and white compliance,” but will be monitoring outcomes and system-wide availability of services. Magellan will submit regular reports on performance indicators, such as how timely claims are paid, timeliness of answering customer calls, time to resolve complaints, and others. There will be data posted daily on Magellan’s website at magellanofidaho.com.
While this new plan is focused largely on Medicaid participants, it also will benefit some individuals who aren’t enrolled in the program. The contract also uses federal Behavioral Health Block Grant money, which is targeted at serving adults with serious mental illness and children with serious emotional disturbances.
The money would go toward services the department previously had been administering, such as the Parenting with Love and Limits, which supports families who have young people with several emotional or behavioral problems.
Idaho is weaving together Medicaid and block grant funds to improve access across the board, Charron said, which makes Idaho’s plan unique among other states.
It will take time for the department to determine if many of the desired outcomes are coming to fruition. Long-term, Charron said her focus is on improving access to services and improving prevention strategies to ensure people are receiving treatment in their communities and avoiding hospitalization.
“Just bringing more of those preventive-type services online because our system is so fragile,” she said. “We’re not unique. This is a national crisis in terms of behavioral health workforce, but I do think Idaho is unique just in the landscape that we live in and the geography of our state.”
She also said she wants to see an improved experience for those individuals trying to get the health care they need.
“I think we had those pieces in place previously, to the extent that we could, but it was not optimal,” Charron said. “I think we’re in a more optimal setup now under Magellan.”
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