September 11, 2024

CoLab Report here:  https://uwcolab.org/reportsandpublications

The State of Washington/Univ. of Washington has been working on the implementation of Evidence Based Mental Health and SUD services paid by Medicaid since at least 2006. In fact there’s lots of positive actions by states trying to do the same.  

MCOs in those states often market how well they are implementing EBPs in their managed care products across populations, including child welfare. WA has tracked the implementation of EBPs since 2020. Here are the hard cold facts in WA: despite tremendous effort and a comprehensive benefits package (Service codes included in the report), with coordinated intent, the utilization of MH/SUD EBPs across the state has hovered between 8% and 10% without an upward trend for four years. EBP implementation is extraordinarily complex and difficult to achieve, and calls into question state policy relying on MCOs as the vehicle to achieve a higher level of EBP access for Medicaid beneficiaries, with a focus on the SPMI/SUD and Child Welfare populations.

The NYS Council is once again laser focused on compelling NYS leaders to carve out BH services from the state’s failed Medicaid managed care program. All New Yorkers deserve more efficient and effective care.
Remember: Last year we learned that MCOs managing BH benefits in NYS are permitted to pocket a total of 11% of the premiums paid to them by the state to ‘manage benefits’. If providers, advocates and policy makers want to build the system of care our kids and youth deserve, we must recover these resources and reinvest them in care. And that 11% doesn’t factor in the millions of dollars MCOs sit on in their ongoing attempts to skirt timely payment laws.

Approximately $400M/year (conservative estimate) would immediately become available to the state to reinvest in our service delivery system upon carving out BH services from MMC. That’s real money that belongs to New Yorkers, not MCOs. That’s real money that can assist us with our workforce shortages. Use of MCOs to ‘manage’ benefits is a losing proposition. There is NO value add, only increased barriers to access care and scarce resources leaving our service delivery systems.

MCOs are being paid handsomely to manage benefits – meanwhile they take months and sometimes years to pay providers, they don’t answer their phones when providers seek assistance, they offer no education, training and technical assistance (as they are paid to do) AND two years ago we caught them sitting on hundreds of millions of dollars the state had failed to recoup from those MCOs that were failing to miss contractual targets re: how much of the money they receive from the state MUST be spent on actual Medicaid services for beneficiaries. And as a result of our advocacy, $500M has been returned to OMH and OASAS and most of those funds have been turned around to providers as rate increases across the OASAS and OMH systems of care.

You can read the CoLab Report here: https://uwcolab.org/reportsandpublications