The Georgia Experience Healthcare Reform 2012 Creating Quality Coverage to Support Sustainable Recovery Agenda  Who are We?  Let’s Talk About Recovery  Health Care Reform: The ACA  Georgia Medicaid: Setting the Context for Change  Medicaid and SUD: Redesign and Expansion  Speak Now! or………… Creating Quality Coverage to Support Sustainable Recovery Dr. Dietra Hawkins [email protected] Amanda Ptashkin, JD [email protected]  Ally for Recovery  Ally for Recovery  Vast Systems Experience  Grassroots Organizer (Children, MH, SUD, VA)  Perspective  Advocate for Health Care      Philadelphia Connecticut Georgia New York/New Jersey VA Oakland, CA Reform  Georgians for a Healthy Future Creating Quality Coverage to Support Sustainable Recovery Neil Kaltenecker [email protected] Dawn Randolph [email protected]  Person in long-term  Ally for Recovery recovery  Former SSA in GA  Faces & Voices Board Member (SE Region)  Criminal Justice Experience  Grassroots Organizer    LEO CO Community Corrections  Advocate for Health Care Reform  Georgia Council on Substance Abuse  Public Policy Expert Who Is On The Call? a) Person in Recovery/Client/Consumer b) Family Member/Care-giver c) Ally for Recovery d) Prevention/Treatment Provider e) Administrator/Policy-maker Do You Know Enough? Are you aware of the essential benefit package that will bring parity for Mental Health and Substance Use Disorder services? 1) 2) Yes No What’s Right with Georgia?  Leader in Peer Support – Georgia Mental Health      Consumer Network “This Close” to having Addiction Peer Support implemented Medicaid Leadership Willingness to Engage in New Ways 1 in 13 Georgians under correctional supervision (we lead the nation!) But, we have…..fiscally conservative leadership who want to spend less on corrections New Commissioner of DBHDD (BH Authority) You! Why Are We Here? Project funded by Community Catalyst that seeks to: 1. Facilitate the development of a model system of coverage that is equipped to meet the complex needs of individuals with substance use disorders; 2. Increase awareness, knowledge and practices throughout the community, provider network, policy environment and media; and 3. Strengthen relationships between advocates and state policymakers. www.healthyfuturega.org/ Let’s Talk About Recovery Addiction is the problem  Over 25 million people in the U.S. have an SUD  In 2007, over 494,000 or 6.5% of Georgians needed but did not receive treatment for alcohol use, another 212,000 or 2.8% needed but did not receive treatment for illicit drugs. Recovery is the solution!  Over 22 million people in this country are in recovery! Definition of Recovery Betty Ford Institute (2007): Recovery from substance dependence is a voluntarily maintained lifestyle characterized by sobriety, personal health and citizenship. SAMHSA (2011): A process of change through which individuals improve their health and wellness, live a self directed life, and strive to reach their full potential 4 Major Dimensions That Support a Life in Recovery (SAMHSA)  Health: overcoming or managing one’s disease(s) or symptoms—for example, abstaining from use of alcohol, illicit drugs, and non-prescribed medications if one has an addiction problem—and for everyone in recovery, making informed, healthy choices that support physical and emotional wellbeing.  Home: a stable and safe place to live;  Purpose: meaningful daily activities, such as a job, school, volunteerism, family caretaking, or creative endeavors, and the independence, income and resources to participate in society; and  Community: relationships and social networks that provide support, friendship, love, and hope. Addiction is a…… a) Disease b) Moral/Emotional Weakness c) Self-inflicted Vice d) Behavioral Problem e) All of the Above f) None of the Above Addiction Treatment & Recovery 1970 Comprehensive Alcohol Abuse and Alcoholism Prevention and Treatment Rehabilitation Act: Created NIAAA & an advocacy vision Recovery Treatment Treatment Recovery 1970 Today . The Likelihood of Sustaining Abstinence Another Year Grows Over Time 100% % Sustaining Abstinence Another Year 90% 80% 70% 60% Over a third of people with less than a year of abstinence will sustain it another year After 1 to 3 years of abstinence, fewer than half return to AOD use After about 5 years of abstinence, only about 14% resume AOD use 86% 66% 50% 40% 30% 36% 20% 10% 0% 1 to 12 months 1 to 3 years 4 to 7 years Duration of Abstinence Dennis, Foss & Scott (2007). An eight-year perspective on the relationship between the duration of abstinence and other aspects of recovery. Evaluation Review, 31(6), 585-612. Recovery is real! Partial Recovery of Brain Dopamine Transporters in Methamphetamine User After Abstinence 3 0 ml/gm Normal Control METH User (1 month detox) METH User (14 months detox) Source: Volkow, ND et al., Journal of Neuroscience 21, 9414-9418, 2001. 2010 Patient Protection & Affordable Care Law Dr. A. Thomas McLellan, Director, TRI AOD Treatment in the US: 77% publically funded, 12% insurance 13,000 AOD Specialty Treatment Programs Serve ~ 2.3 million <1% “Untreated” Abuse/Dependent ~ 25 million = 8% Healthcare Reform + Parity Law ~ Medicaid Expansion “Harmful Users” ~60,000,000 Abstinent & Non-Problem AOD Users ~ 83% 2008 National Survey on Drug Use & Health US Population = 309,800,000 Comparing Addiction With Other Chronic Medical Illnesses Hypertension Diabetes Asthma  No Doubt They Are Illnesses  All Chronic Conditions  Influenced by Genetic, Metabolic and Behavioral Factors  No Cures but Effective Treatments are Available McLelland, A. T. (2003). What’s wrong with addiction treatment? NAADAC Conference TRUE OR FALSE? The recovery rates after alcohol or other drug (AOD) use treatment are as good or better than the recovery rates of people treated for other chronic illnesses like diabetes or hypertension. 1. 2. True False 100 90 50 40 30 20 30 to 50% 60 50 to 70% 70 50 to 70% 80 40 – 60% Percent of Patients Who Relapse Relapse Rates Are Similar for Addiction and Other Chronic Illnesses 10 0 Drug Type I Hypertension Asthma Dependence Diabetes McLellan, A.T. et al. (2000). JAMA, 284 (13) Why Health Care is Changing •The status quo is unsustainable -Health care spending is growing faster than the economy and wages •Health status and outcomes are inadequate -They drive increased costs -United Health Foundation study ranks Georgia in the bottom of the nation: 43rd overall (2009) •Americans have insufficient access to health insurance coverage -Adds to the system’s inefficiency -Leads to worse outcomes and higher costs Georgians Have Insufficient Access to Coverage (Non-elderly Georgians in 2007-2008) Uninsured 19% Public Coverage 17% Other Private 4% Employer Coverage 60% Health Care Reform: The ACA PATIENT PROTECTION AND AFFORDABLE CARE ACT: MARCH 2010           Builds on current system to expand coverage The tax-preference for employer coverage remains Expands existing programs to cover lowest-income Americans (Medicaid) Provides subsidies for small businesses & middle-income individuals without employer coverage Increases coverage for preventive care Invests in health care infrastructure Pilots projects for payment reforms Individual Mandate State-based Health Exchanges Employer-based “carrots” and “sticks” to increase health increase coverage Health Care Reform: The ACA Already in Effect  $250 Medicare drug cost rebate (donut hole)  Expanded coverage for young adults up to age 26  Small business tax credits  Launch of www.healthcare.gov  All new plans must cover certain preventive services  No rescissions and elimination of lifetime/annual limits on insurance coverage  Prohibition of denial of coverage for children with pre-existing conditions  Monitoring unreasonable rate hikes  Rebuilding the primary care workforce  Establishing consumer assistance programs  Medical Loss Ration: Rebate checks  Pre-existing condition insurance plan (PCIP) Restructuring the Insurance Marketplace: The Exchange  Online marketplaces designed to help individuals and small employers obtain private-market coverage; Focused on individual and small group markets; Must be implemented by 1/1/14  Like Orbitz, Travelocity, E-Insurance.com—you have a matrix of options, facilitates apples to apples comparison  Insurance plans sold on the exchange must include “essential health benefits”, final regulations to be released shortly  Subsidies and credits, based on income (which can fluctuate) 100%-400% FPL  State is currently convening Commissioners Task Force; holding public meetings; determining how to move forward  Check out GHF Issue Brief for more The Exchange: Affordability Provisions  Individuals can purchase health insurance on the exchange or outside the exchange, but tax credits are only available within the exchange  Sliding scale credits that limit the percentage of income that can be spent on premiums:       Up to 133% FPL: 2% of income 133-150% FPL: 3 -4% of income 150-200% FPL: 4 – 6.3% of income 200 – 250% FPL: 6.3 – 8.05% of income 250 – 300% FPL: 8.05 – 9.5% of income 300 – 400% FPL: 9.5% of income  Credits also available to help with out-of-pocket costs Potential Medicaid Eligibility Changes in Georgia Selected Populations Current Eligibility New Eligibility Children (6-18 years-old) Peachcare for Kids with 100-133% FPL a premium Medicaid with no premium Adults with Children Medicaid available for those at or below 29% FPL Medicaid available for those at or below 133% FPL Adults with no children None Medicaid available for those at or below 133% FPL ~650,000 to 900,000 newly eligible for public insurance. Source: Georgia Health Policy Center Georgia Medicaid: Setting the Context  Behavioral Health Context:  DBHDD is the policy manager, definition designer, provider network manager, utilization review organization, co-funder for DCH/Medicaid.  In other words, DBHDD is the Managed Care Organization for DCH for the following populations:     Aged, Blind, Disabled (Adults and Youth) Foster Care Youth Managed Care Covered (CMOs) in the “Gap” Over 50,000 “covered lives” • • ~32,000 Adults ~20,000 Youth Georgia Medicaid Rehab Option             1-800 Crisis and Access Line Diagnostic Assessment Individual Counseling Group Training/Counseling Family Training/Counseling Physician Assessment and Care Nursing Assessment and Care Medication Administration (including Opioid Maintenance) Crisis Intervention Community Support (Skills Training and Care Coordination) Peer Support         Intensive Outpatient Programs Residential (mostly Women’s programs) Ambulatory Detoxification Crisis Stabilization and Residential Detoxification Prevention Services DUI Schools Adolescent Clubhouse Models SBIRT Medicaid Redesign Last year, DCH began a comprehensive assessment and recommended redesign of Georgia's Medicaid Program and PeachCare for Kids® Over the past year, DCH convened three taskforces and a number of work groups to assist them in the redesign process. For the first time SUD was at the table—there was a SUD/MH specific workgroup that met regularly and ultimately submitted 66 pages of recommendations. Despite the fact that the state decided to hold off on a fullscale redesign, we will continue to remain engaged and at the table! Medicaid Expansion  The Supreme Court upheld the ACA but effectively made the Medicaid expansion OPTIONAL for states.  In August, Gov. Deal announced he has no intention of moving forward with the expansion…which would effectively leave folks between current eligibility and 138% of FPL with NO options for coverage.  Also would mean that childless adults would not be eligible for coverage, the state loses out on 100% federal funding for the first three years, and the health care infrastructure will continue to suffer the costs of uncompensated care.  Under the ACA, SUD is part of the essential benefit package so we are helping to shape services that support recovery! We need to make sure that Medicaid will be available to to those additional people. Medicaid Expansion Costs for GA Cumulative Spending from 2014 to 2019 New Federal Funds, $14,551  New state funds average $120 million for the first six years  New state funds ≈ 2.7% increase above baseline without reform ($’s in millions) Source: Kaiser Commission on Medicaid and the Uninsured New State Funds; $714 Meanwhile… In July, Governor Deal directed DCH to make: o 3% cuts in the admin budget for FY2013 amended budget and FY2014 budget. o 3% cut in services for FY2013 amended and a 5% cut in services for FY2014. o These cuts amount to about $170 million. With a services budget currently running a $300 million deficit, DCH needs to find $470 million. Additionally, DBHDD was given a similar directive… Cover Georgia  Georgians for a Healthy Future has begun a state-wide coalition to effectively mobilize and advocate for the expansion our Medicaid program.  November 15th Cover Georgia Coalition Meeting: AARP Offices 10am to 12pm  Workgroups include:     Community Outreach Legislative Targets Media and Messaging Workforce  In order to convince the state that this is the right choice for GA, we need all hands on deck! Advocacy Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has. --Margaret Mead Addiction Recovery Awareness Day: SAVE THE DATE January 15th, 2013 Georgia State Capitol Advocacy  Advocacy may seem overwhelming, but it’s a lot easier—and can have a bigger impact—than you might imagine. You already have the knowledge, passion, and commitment to be a successful and effective health care advocate. All you need are the right tools.  HOOK: The hook is the start of any conversation  LINE: The line is why this issue is important to you  SINKER: The sinker is where you take the opportunity to make your ask  SHARING YOUR STORY Speak Now!  Plug In /Sign Up: www.healthyfuturega.org  Like it. Tweet it. Share it. Use Social Media to your benefit!  Make a call, send a letter or an email  Television, newspaper, radio  Community-level organizations and peers!  Share with your colleagues/friends/family  We need your feedback! What’s the Message?  Services that are now available  The opportunity that the expansion provides for people with substance use disorders  We have to build supports around sustainable recovery  There is hope—this is just the beginning  The implications of these improvements span far beyond just the individual but goes to families, communities, etc. Do You Know Enough? Have you heard enough about the ACA changes that will directly impact you and the people you serve? 1) 2) Yes No Speak Now!  Where do we need to share the message in regard to the opportunities that the ACA brings for wellness, hope and integrated health?  Would you like to help advocate for mental health and substance abuse services?  If Yes, in what ways would you like to advocate?  Would an advocacy training (either in person or by phone/webinar) be helpful to you as an advocate?  What other tools do you need in order to share this information with others and get them involved in our efforts? Creating Quality Coverage to Support Sustainable Recovery There is a lot of synergy … Questions Comments Thank You! Please Stay in Touch! D R . D I E T R A H AW K I N S D R . D I ET RA HAW K IN S @G MA I L.COM N E I L K A LT E N E C K E R N E I L @ G A S U B S TA N C E A B U S E . O R G A M A N D A P TA S H K I N A P TA S H K I N @ H E A LT H Y F U T U R E G A . O R G DAW N R A N D O L P H D A W N @ D I R C O N S U LT I N G G R O U P. C O M Creating Quality Coverage to Support Sustainable Recovery www.healthyfuturega.org www.gasubstanceabuse.org