Illinois wins Medicaid flexibility under Trump

Illinois Gov. Bruce Rauner has received federal approval to use $2 billion in Medicaid funding differently, a longtime goal that his predecessor Pat Quinn originally sought.

The state plans to boost behavioral health services and combat the fast-paced opioid crisis as part of the new Better Care Illinois Behavioral Health Initiative. After all, about 25% of low-income and disabled people on Medicaid in Illinois have behavioral health needs, but they account for 52% of all spending, according to the state. About 3 million people in Illinois are on Medicaid; 1 of every 7 adults under 65, per the Kaiser Family Foundation.

"This effort puts a strong new focus on prevention and public health; pays for value and outcomes rather than volume and services; makes evidence-based and data driven decisions; and moves individuals from institutions to community care, to keep them more closely connected with their families and communities," Rauner said in a statement.

The governor, who is fighting for a second term, is betting his latest healthcare initiative will save the state money by getting Medicaid recipients help earlier, particularly those caught up in the nationwide opioid epidemic. In Illinois, the crisis is filling hospital ERs and treatment centers. It's afflicting newborn babies whose mothers used opioids while pregnant, whether legally or not. The mounting cost is a burden to Medicaid in particular.

Illinois received a so-called 1115 waiver from the Trump administration, which gives the state flexibility in how it uses Medicaid dollars instead of the typical federal rules. Rauner applied for the waiver in October 2016. As of March 5, 36 states had 44 waivers, using them for everything from covering people who previously weren't eligible for Medicaid to imposing work restrictions on recipients and charging them copays, according to Kaiser.

Beginning July 1, Rauner plans to use the waiver to launch 10 pilot projects for services that Medicaid didn't previously cover, including:

• Short-term substance use treatment at certain inpatient and residential facilities.
• Withdrawal management services, including medication and intake/discharge at a facility.
• Home visits to women who had a baby within 60 days, and to babies born with withdrawal symptoms until they turn 5. (There's a big uptick in Illinois babies born, then withdrawing from opioids their moms used while pregnant.)
• Services to help recipients find and keep a job, including job coaching and transportation.
• Intensive in-home services to stabilize behavior that may lead to a crisis, hospitalization or residential care.

"These additional services are expected to transform the behavioral health system in Illinois because beneficiaries will have access to less costly community-based services," CMS Administrator Seema Verma wrote in a May 7 letter to Felicia Norwood, director of the Illinois Department of Healthcare and Family Services, the agency that oversees Medicaid.

Some of the pilot programs will have geographic and enrollment limits, Illinois HFS spokesman John Hoffman said.

Illinois didn't get everything it wanted covered under the waiver, such as helping Medicaid recipients cover their rent.

The state has five years of flexibility for how it spends $2 billion. It's a fraction of Illinois Medicaid spending, which is about $21 billion a year.

Sara Howe, CEO of the Illinois Association for Behavioral Health, a nonprofit that represents treatment providers, said the pilot programs CMS approved show government officials are concerned about the impact of the opioid crisis. They're creating ways to get people into treatment faster, she said, though gaps in addiction treatment will remain.

"The devil is in the details, of course, about implementing it," Howe said.

But she's excited. She's waited years for the waiver to come through.

"Rauner wins Medicaid flexibility under Trump" originally appeared in Crain's Chicago Business.