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.