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Under­stand­ing the Illi­nois 1115 Waiver

Con­tent pro­vid­ed by Grace Hong Duf­fin, Chief Oper­at­ing Officer

Last week, Illi­nois approved $2 bil­lion of fund­ing des­ig­nat­ed to Men­tal Health and Sub­stance Use Projects through a Med­ic­aid Waiver.

While this approval is promis­ing for the future men­tal health treat­ment sys­tem in Illi­nois, the details of this waiv­er are still being finalized.

The 1115 Med­ic­aid Waiv­er pro­pos­al is the cor­ner­stone of Gov­er­nor Rauner’s Behav­ioral Health Trans­for­ma­tion Plan, tout­ing near­ly $2 bil­lion in new invest­ments to imple­ment 10 pilot pro­grams over the next 5 years. These waiv­er projects will seed inno­v­a­tive treat­ment ser­vices and help build a more com­pre­hen­sive con­tin­u­um of care for peo­ple liv­ing with behav­ioral health issues. 

Per the Depart­ment of Health­care and Fam­i­ly Ser­vices’ (HFS) notice, Illi­nois believes that the re-bal­anc­ing of behav­ioral health ser­vices and the inte­gra­tion of phys­i­cal and behav­ioral health­care will pro­duce sub­stan­tial sav­ings to the Med­ic­aid pro­gram. To ensure that the behav­ioral health trans­for­ma­tion project is bud­get-neu­tral, the State will com­mit to a 2% reduc­tion in spend­ing com­pared to what spend­ing would be with­out the waiv­er and state plan amend­ments. This reduc­tion in spend­ing is what Illi­nois is request­ing be rein­vest­ed in the Trans­for­ma­tion. The sources of these sav­ings include, but are not lim­it­ed to:

  • Com­pre­hen­sive man­age­ment of mem­bers, par­tic­u­lar­ly adults who expe­ri­ence Opi­oid Use Disorders/​Substance Use Disorders; 
  • Deflect­ing mem­bers with behav­ioral health con­di­tions away from high-cost insti­tu­tion­al ser­vices when unnec­es­sary, ensur­ing prop­er man­age­ment under com­mu­ni­ty-based services; 
  • Sta­bi­liz­ing behav­ioral health con­di­tions and co-mor­bid med­ical con­di­tions to avoid long-term Med­ic­aid eli­gi­bil­i­ty for some indi­vid­u­als. For oth­ers, the out­come of ear­ly inter­ven­tion will result in con­di­tions that are eas­i­er to man­age and less cost­ly than dis­abil­i­ty-relat­ed Med­ic­aid; and 
  • Design­ing a val­ue-based pay­ment and deliv­ery sys­tem that ensures provider respon­si­bil­i­ty for deliv­er­ing the right care, in the right place, at the right time, at the right cost.” 

In oth­er words, HFS sug­gests this Waiv­er will result in enough cost sav­ings to achieve that 2% reduc­tion, which will lead to more mon­ey being infused into the behav­ioral health system. 

The Waiv­er dove­tails with the Administration’s Inte­grat­ed Health Homes State Plan Amend­ment to improve the coor­di­na­tion of phys­i­cal and men­tal health­care, expand com­mu­ni­ty-based and in-home ser­vices, and reduce the need for emer­gency and high-end services.

Approved ser­vices include:

  • sub­stance use treat­ment and recov­ery services 
  • case man­age­ment for indi­vid­u­als with sub­stance use conditions 
  • hous­ing ser­vices and com­mu­ni­ty inte­gra­tion assistance 
  • sup­port­ed employ­ment services 
  • cri­sis sta­bi­liza­tion and intervention 
  • peer recov­ery sup­port services 
  • evi­dence-based home visits 
  • respite ser­vices

More infor­ma­tion will fol­low in the weeks and months to come as these changes con­tin­ue to unfold at the state lev­el. KYC looks for­ward to the poten­tial­ly pos­i­tive changes that may come from this 1115 Waiv­er for behav­ioral health ser­vices as we con­tin­ue to meet the needs of our community.

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