SUBSTANCE USE TREATMENT SYSTEM MEDI-CAL AND OTHER PAYORS- MINORITY - PowerPoint PPT Presentation

SUBSTANCE USE TREATMENT SYSTEM – MEDI-CAL AND OTHER PAYORS- MINORITY ADVISORY COMMITTEE Presented by Kakoli Banerjee, Ph.D. Director, Research & Outcome Measurement Substance Use Treatment Services May 2016

Substance Use Treatment Services (SUTS) – System of Care (SoC)  System of care organized as a continuum with different intensities of treatment – (treatment modalities)  Detox, residential, outpatient, Addition Medicine  Ancillary services such as Transitional Housing for OP clients, psychiatric services, case management, etc  Admission based on treatment need, not insurance status  Functions as a safety net system  Placement based on ASAM level of care assessment – not diagnosis per se

Substance Use Treatment System-A different financial landscape  SUTS services have been funded mainly by county general fund dollars for many years  Limited Medi-Cal funding for treatment modalities  Partial Medi-Cal funding for services within treatment modalities  MediCal revenues made up 3% of SUTS funds in 2015  Limited insurance for services in public sector treatment systems

Substance Use Treatment System- Current funding sources  Limited reimbursement from Medi-Cal  Very little reimbursement from Medi-Cal and third party payors.  Modest increases in Medi-Cal reimbursements in past fiscal year (since ACA)  Annual budget is less than 1/5 th of Mental Health Services  FY 2015 – MH $266.6  FY 2015 – SUTS-$ 50.5 million  SUTS -smaller system with fewer admissions annually

Substance Use Treatment Modalities funded by traditional Medi-Cal-2015 General fund Partially funded services ONlY by Medi-Cal* • Residential tx • Outpatient • Social detox • School-based • Transitional housing • Medication assisted treatment • Case management • Perinatal Outpatient • Psychiatric services • Vivitrol * Selected services are reimbursed for these modalities

OP & AMT – Medi-Cal, County General Funds and Other Payors General Realignment Other SUTS Modalities fund MediCal Total Cost payors dollars List all modalities Outpatient Services $1,739,017 $424,551 $144,841 $241,925 $2,550,334 Narcotic Replacement Therapy $2,853,746 $1,065,015 $408,730 $0 $4,327,491 TOTAL $4,592,763 $1,489,566 $553,571 $241,925 $6,877,825

The present and future of Substance Use Treatment Services funding

Changes in funding landscape for Substance Use treatment-After 1/1/2014  ACA – Health Care Reform  Substance use services – one of the 10 essential benefits  Expansion of Medi-Cal eligibility to single, childless adults (majority of SUTS clients)  Result was that previously ineligible clients became eligible for reimbursable services  Expansion in services and modalities were limited  MediCal Waiver  Expands reimbursable services for Medi-Cal eligible clients

Changes Traditional Medi-Cal Medi-Cal Expansion Medi-Cal Waiver Before ACA With ACA Proposed expansion - Future Eligibility – Eligibility- Eligibility- Limited to pregnant, Expanded to single, No change parenting women, opioid childless adults addiction Modalities- Perinatal, Modalities- Perinatal, Modalities- Includes Addiction Medicine, OP Addiction Medicine, OP detoxification services, residential, recovery services, case mgmt Reimbursable services- Reimbursable services- Expansion of services to Assessment Assessment include services under Crisis intervention Crisis intervention the above modalities and Discharge planning Discharge planning bed days for residential Grp tx Grp tx tx Intake Intake

Medi-Cal Admissions Substance Use Treatment System-After ACA -FY 2015  Shift in status of existing clients  Relatively few new clients in the first 18 months

Monthly admissions to all modalities by Payor-2015 Figure 1. MediCal clients as a percent of monthly admissions (FY 2015) 120 100 80 60 40 20 34 35 33 33 30 31 31 31 30 28 28 28 0 MediCal (C50) Other Payors

MediCal Payor at Admission for OP & AMT only – FY 2015 FIGURE 2. MEDI-CAL AT ADMISSION - OP & AMT FY 2015 47.4 45.1 44.7 43.9 43.6 42.3 42.2 38.5 38.4 35.3 34.1 31.3 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15

Substance Use Treatment Clients 2015 Who are our clients? What are our client characteristics?

Figure 3. Race/ethnicity at admission to SUTS tx services (FY 2015) n=8247 Race & ethnic composition of treatment population Racial and ethnic minorities White/Cauc, 34 make up the majority of the clients admitted to treatment in Hisp/Latino, 48 FY 2015 Total admissions FY 2015 = 8247 Minority clients accounted for 66% of admissions during 2015 Mixed/other, 3 African-Am, 8 Hispanic/Latino clients made up 48% of admissions, Asian/PI, 7 Native Amer, 2

Age and Race-ethnicity of clients at admissions to SUTS Tx - FY 2015 Figure 4. Age and race/ethnicity at admission to SUTS tx services (FY 2015) n=8247  Latino-Hispanic clients made up 120.0% the majority of clients under the 100.0% age of 34 years 9.5% 29.0% 33.2% 30.8% 31.4% 36.4% 42.9% 51.9% 44.4% 37.7% 80.0%  78% of youth were Latino-Hispanic 60.0%  White clients made up the majority of older clients (50 years and 40.0% 78.0% older) 54.7% 48.1% 50.7% 49.0% 45.7% 38.8% 20.0% 26.3% 33.6% 36.7%  Medi-Cal eligibility changes had the 0.0% largest impact on single adults Under 19-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60+ 18 yrs Hispanic Native American Asian/PI African-Am Mixed/other White

Gender distribution at admission to SUTS – FY 2015 Single, males made up most Figure 5. Gender distribution – of the admission n=8247 .2  The majority of clients admitted to SUTS were men (67.7%) 32.2  Women made up 32.2% of admissions 67.7  Clients of “other’ gender made up 0.2% of admissions Female Male Other

Paid employment in past month – FY 2015 Figure 6. Paid employment in 30 days before admission - FY 2015  At admission, 82% reported 90 82 having no paid work days in the 80 previous month 70  9% worked at between 1 and 15 60 days 50 40  7% worked between 16 and 29 30 days 20  Only 2% worked for 30 days 9 7 10  Profile of a population in need of 0 1 safety net services No paid employment 1 to15 days 16 to 29 days 30 days

Figure 7. Client zipcodes at admission-FY 2015 No zip Where our clients live SJ-East SJ-South 33% did not provide a zipcode- SJ-West 6.9 32.7 SJ-Central most of these clients are South Cty 9.0 homeless Santa Clara Sunnyvale 9.9 14.9% came from East San Jose SJ-North 14.9 13.8 Campbell 13.8% came from South San Jose NE Cty Mountain View 9.9% came from West San Jose Other cities 9% came from Central San Jose 6.9% came from south county

Table 8. Primary & secondary drug at admission- FY 2015 50.0 45.0 40.0 Primary & secondary drug at admission-Methamphetamines 35.0 & Alcohol % of admissions 30.0 Methamphetamines was the 25.0 primary drug in 43.6% admissions 20.0 and the secondary drug in 13.4% admissions 15.0 10.0 5.0 Alcohol was the primary drug for 24.8 % in admissions and 0.0 secondary in 16.6 % of admissions Primary Secondary

Comments & Questions 20