Presentation to the House Committee on Public Health Gary Jessee, Deputy Executive Commissioner, HHSC Sonja Gaines, Associate Commissioner, HHSC Mike Maples, Assistant Deputy Commissioner, DSHS February 21, 2017
Medicaid Eligibility Medicaid Serves: Low income families Children Pregnant women Former Foster Care Youth Elderly People with disabilities Eligibility Criteria for Medicaid: Residency in Texas U.S. citizenship or qualified non-citizen status Income limits, plus factors such as age or pregnancy and in some cases resource limits 2
Medicaid/CHIP Delivery Models Fee-for-Service (Traditional Medicaid): Medicaid pays for services to clients to enrolled providers on fee-for-service basis Managed Care: STAR (State of Texas Access Reform) - Children’s Medicaid and CHIP Dental provides primary, acute care, and Services - provides dental services for pharmacy serves for children, pregnant most children and young adults women, and some low income families CHIP - provides primary and acute care STAR+PLUS - integrates acute care and services for children who are not LTSS for people with disabilities or who otherwise insured, or who aren’t are age 65 and older eligible for Medicaid (Services are STAR Kids - provides acute care and delivered solely through managed care) LTSS for children with disabilities Dual Demonstration - serves people in STAR Health - provides acute care and Medicare and Medicaid (duals) in six LTSS for children in foster care counties through a state-federal managed care demonstration 3
1115 Transformation Waiver Overview Managed care expansion Allows statewide delivery of Medicaid managed care services (STAR, STAR+PLUS, and Children’s Medicaid Dental Services) while preserving historical upper payment limit (UPL) funding Hospital financing component Preserves UPL hospital funding under a new methodology Creates Regional Healthcare Partnerships (RHPs) Five year waiver 2011 – 2016 Extension through December 2017 In January, HHSC requested an additional 21 months, through September 2019. 4
Women’s Health Programs Healthy Texas Women (HTW) Newly created HTW program launched on July 1, 2016 Consolidated the Texas Women’s Health Program and the Expanded Primary Health Care Program Provides women’s health and family planning services at no cost to eligible, low-income women Family Planning Program (FPP) Provides family planning health care services to eligible men and women Breast and Cervical Cancer Services (BCCS) Provides low-cost, accessible breast and cervical cancer screening and diagnostic services to women 5 5
Women’s Health Programs Healthy Texas Family Planning Breast and Cervical Women Program Cancer Services Income 200% FPL 250% FPL 200% FPL Gender Female Male or Female Female Age 15-44 (15-17 with 64 and younger 18-64 parental consent) Application Clients may apply by Eligibility determined at Eligibility determined at paper application or point of service point of service online Eligibility U.S. citizen or qualified Texas Resident Texas Resident non-citizen Pregnancy Not pregnant N/A N/A 6
Early Childhood Intervention (ECI) ECI is a statewide program for families with children, birth to three years old, with disabilities and developmental delays. To be eligible for services, a child must have: A developmental delay of at least 25 percent that affects functioning in one or more areas of development; A medically-diagnosed condition that has a high probability of resulting in a developmental delay; or An auditory or visual impairment as defined by the Texas Education Agency. HHSC contracts for services with local agencies and organizations. 7 7
Behavioral Health Services Office of Mental Health Coordination Statewide Behavioral Health Strategic Plan 9,030 veterans and families projected to be served in fiscal years 2016-2018 Community mental health services 82,523 adults and youths served per month (average) A total of 190,207 adults and youth served Substance abuse prevention, intervention, and treatment Over 2.1 million youths and adults provided prevention services 37,015 youths and adults provided treatment services 89,750 youths and adults provided intervention services Community Crisis Services 82,124 served in crisis outpatient services 22,051 served in crisis residential services 11,709 individuals served in inpatient beds 8
Statewide Behavioral Health Strategic Plan The 84th Legislature created the Statewide Behavioral Health Coordinating Council for the purpose of creating a five-year statewide behavioral health strategic plan to: Eliminate redundancy Utilize best practices in contracting standards Perpetuate identified, successful models for mental health and substance abuse treatment Ensure optimal service delivery Identify and collect comparable data on results and effectiveness The council includes members from 14 state agencies that receive funding for behavioral services. 9
Behavioral Health Services 500,000 adults in Texas live with a serious and persistent mental illness; nearly 250,000 children have a serious emotional disturbance. Adults with untreated mental health conditions are eight times more likely to be incarcerated than the general population, and are more likely to have comorbid conditions. 1.7 million veterans in Texas may seek behavioral health treatment. Approximately 26,300 Texas students receive special education services with a primary diagnosis of emotional disturbance. Approximately 50 percent of youth in the juvenile justice system have been identified with need for mental health treatment; approximately 80 percent of state committed youth need alcohol or drug use treatment. 10
Behavioral Health Populations Behavioral health issues touch many different populations across Texas who interact with different systems and can experience unique challenges in accessing and receiving services. Populations include: Individuals with intellectual and developmental disabilities Individuals involved within the criminal justice system School-age children or those involved with the school system Veteran and military populations and their families Children and adolescents in foster care Individuals experiencing or at risk for homelessness Individuals with physical illnesses (including blind, hearing-impaired) Aging Texans 11
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State Hospitals Eleven state mental health hospitals provide inpatient or residential psychiatric treatment to adults and/or children and adolescents: Austin Rio Grande State Center Big Spring Rusk El Paso San Antonio Kerrville Terrell North Texas – Vernon Waco Center for Youth North Texas – Wichita Falls DSHS also operates: Texas Center for Infectious Disease for inpatient Tuberculosis and outpatient Hansen’s Disease treatments Outpatient Clinic at Rio Grande State Center that provides primary health care to residents of four South Texas counties 13
State Hospitals More than 2,000 people served per day, including: Adults, children, and adolescents Voluntary commitments Civil commitments Forensic commitments: Individuals not competent to stand trial Individuals found to be not guilty by reason of insanity Forensic population makes up approx. 58 percent of all state hospital patients Services include: Psychiatric treatment for adults, children, and adolescents Residential treatment Competency restoration 14
State Hospitals 84th Legislature funded 2,463 beds across all hospitals. Staffing trends and hospital infrastructure have reduced capacity to 2,285. $250 Deferred Maintenance Requests: 2008-2017 $199 $198 $198 $200 $181 $166 $150 Millions $89 $100 $77 $69 $68 $45 $50 $33 $27 $26 $18 $0 $0 2008-09 2010-11 2012-13 2014-15 2016-17 15 Need Amount Requested Amount Funded
State Hospitals Forensic Waiting Lists for State Mental Average Length of Stay for: Incompetent to Stand Trial (non-max Health Hospitals: August 2008 - December security) pop: 153 days 2016 Civil population: 66 days Voluntary patients: 51 days Forensic Maximum Security Overall 450 Wait list for a maximum security unit (MSU) has 400 been as high as 306 in fiscal year 2017 to date. 350 300 Average time spent on the MSU wait list is 169 250 200 days, but wait times can be 400+ days for highly 150 specialized care, including multiple disabilities, 100 social learning and rehabilitation programs. 50 0 Aug-08 Feb-09 Aug-09 Feb-10 Aug-10 Feb-11 Aug-11 Feb-12 Aug-12 Feb-13 Aug-13 Feb-14 Aug-14 Feb-15 Aug-15 Feb-16 Aug-16 16
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