Understanding Changes to Medicaid Behavioral Health Care in New York. Consumer/Recipient Education Forum

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1 Understanding Changes to Medicaid Behavioral Health Care in New York Consumer/Recipient Education Forum MARCH July

2 Presentation Overview What are the Goals for the Medicaid Changes? What is Medicaid Managed Care? Changes to Medicaid Behavioral Health (mental health and substance use) Care Health and Recovery Plans (HARPs) Home and Community Based Services (HCBS) Qualifying for a HARP Questions 2

3 What are the Goals for the Medicaid Changes? Better Health Better Care Greater Access Lower Costs 3

4 Changes to Medicaid Behavioral Health Services Who will see these changes? People 21+ with Medicaid Managed Care ONLY People 21+ receiving SSI ONLY Most people with Medicaid will have some changes in the way they get mental health and substance use services 4

5 Right now, these changes are not for people who: Have both Medicaid and Medicare Live in a nursing home Are in a Managed Long Term Care Plan Are under age 21 Have services from the Office for People with Developmental Disabilities (OPWDD) 5

6 What is Medicaid Managed Care? 6

7 Medicaid Managed Care Plan Medicaid Managed Care plan a health insurance plan for people who get Medicaid benefits Medicaid Managed Care plans contract with a network of providers to deliver all covered benefits and services, to help people get and stay healthy and get the medical care they need 7

8 Medicaid Managed Care Covered Services: Mental Health Mental Health Inpatient Rehabilitation Mental Health Clinic Partial Hospitalization Personalized Recovery Oriented Services (PROS) Assertive Community Treatment (ACT) Continuing Day Treatment (CDT) Comprehensive Psychiatric Emergency Program (CPEP) Intensive Psychiatric Rehabilitation Treatment (IPRT) Crisis Intervention 8

9 Medicaid Managed Care Covered Services - Substance Use Disorders Inpatient Substance Use Disorder Treatment Opioid, Including Methadone Maintenance, Treatment Outpatient Clinic Detox Services Residential Services 9

10 Changes to Medicaid Behavioral Health 10

11 How Is My Care Changing? Medicaid Managed Care Plans currently provide physical health and some behavioral health care services for people with Medicaid Now, plans will provide additional mental health and substance use benefits for people Medicaid Managed Care plans will send a letter to all people letting them know that their plan now provides expanded behavioral health benefits 11

12 What Do These Changes Mean? Medicaid Managed Care plans will expand their efforts with behavioral health care to help people reach their health, recovery, and life goals Medicaid Managed Care will offer new behavioral health services that people can get in their community Doctors and other service providers will work together to help Medicaid Managed Care people meet their chosen health, recovery, and life goals 12

13 Health and Recovery Plans (HARPs) 13

14 Health and Recovery Plans (HARPs) New type of Medicaid Managed Care plan Designed for people with serious mental health conditions and substance use disorders Cover all benefits provided by Medicaid Managed Care plans, including expanded behavioral health benefits Also provide additional specialty services to help people live, go to school, work and be part of the community 14

15 How are HARPs different than other managed care plans? HARPs specialize in serving people with behavioral health conditions HARPs cover additional rehabilitative services called Home and Community Based Services (HCBS) Some people in HARPs will be eligible for HCBS A Care Manager will help people in HARPs and service providers work together 15

16 Home and Community Based Services (HCBS) 16

17 Home and Community Based Services (HCBS) Help people improve their quality of life, including getting and keeping jobs, getting into school and graduating, managing stress, and living independently Designed to help people meet their recovery and life goals Only available to people in HARP and HIV Special Needs Plans Only available for people who qualify 17

18 Home and Community Based Services (HCBS) Find Housing. Live Independently. Psychosocial Rehabilitation Community Psychiatric Support and Treatment Habilitation Non-Medical Transportation for needed community services Return to School. Find a Job. Education Support Services Pre-Vocational Services Transitional Employment Intensive Supported Employment Ongoing Supported Employment Manage Stress. Prevent Crises. Short-Term Crisis Respite Intensive Crisis Respite Get Help from People who Have Been There. Peer Support Services Family Support and Training 18

19 HCBS Assessment In order to get HCBS, people will need an assessment Assessment shows if people are eligible for HCBS and which HCBS they need People in HARPs will have a Health Home Care Manager who completes the assessment Care Managers also help people in HARPs make a Plan of Care A Plan of Care identifies life goals and the services people need and want to help reach their goals People s ideas and what they want will be very important in making the Plan of Care 19

20 When Do These Changes Happen? 20

21 When do these changes happen? Medicaid eligible people who live in New York City Medicaid Managed Care plans are scheduled to begin coverage of expanded behavioral health services in October 2015, pending federal approval Home and Community Based Services will become available later to eligible people in HARPs and HIV SNPs 21

22 When do these changes happen? Medicaid eligible people who live outside of New York City Medicaid Managed Care plans are scheduled to begin to cover the expanded behavioral health services in July 2016, pending federal approval 22

23 Qualifying for a HARP 23

24 How do people know if they qualify for a HARP? HARP eligible people will get a letter telling them they are eligible and how to enroll. The letter will tell people: About their choices for joining a HARP What to do next Where to get more information Questions? Call OMH Office of Consumer Affairs:

25 Joining a HARP Passive Enrollment Some people who are eligible for HARP enrollment do not have to do anything to join - they will be automatically enrolled in the HARP that is run by the company that runs their current Medicaid Managed Care plan. These people will get a notice to tell them: That they are eligible for HARP enrollment That they do not need to take action to join a HARP How to choose a different HARP if they want to That they can choose not to be in a HARP and can stay in their current plan That they must respond to the notice to opt out That people will be taken out of the current plan and moved into the HARP 25

26 Joining a HARP Active Enrollment Other people who are eligible for HARP enrollment will have to choose to enroll in a HARP the company that runs their current Medicaid Managed Care plan does not offer a HARP These people will get a notice to tell them: That they are eligible to join a HARP How to join a HARP Who to call if they want to join a HARP 26

27 Joining a HARP for People in HIV Special Needs Plan (SNP) HIV Special Needs Plans (SNPs) cover the expanded behavioral health services covered by a Medicaid Managed Care plan, plus the specialty services covered by HARPS HIV SNPs also provide additional care that is NOT covered by other plans HARP eligible people enrolled in an HIV SNP will also receive a notice to tell them: They are eligible for HARP enrollment That they can stay in their HIV SNP plan and get HCBS if they are eligible That they do not need to take action to be eligible for the extra benefits that HARPs provide If people want to leave the HIV SNP to enroll in a HARP, they may lose some specialty services that are only available through the HIV SNP 27

28 Where Can People Get More Information? NYS Office of Mental Health (OMH) Office of Consumer Affairs: Office of Mental Health Office of Alcoholism and Substance Abuse Services (OASAS) Department of Health (DOH) For information about Home and Community Based Services 28

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