Presentation to the House Committee on Public Health Gary Jessee, - - PowerPoint PPT Presentation

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Presentation to the House Committee on Public Health Gary Jessee, - - PowerPoint PPT Presentation

May 14, 2023 414 likes •592 views

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

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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

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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

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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) - provides primary, acute care, and pharmacy serves for children, pregnant women, and some low income families

STAR+PLUS - integrates acute care and LTSS for people with disabilities or who are age 65 and older

STAR Kids - provides acute care and LTSS for children with disabilities

STAR Health - provides acute care and LTSS for children in foster care

Children’s Medicaid and CHIP Dental Services - provides dental services for most children and young adults

CHIP - provides primary and acute care services for children who are not

  • therwise insured, or who aren’t

eligible for Medicaid (Services are delivered solely through managed care)

Dual Demonstration - serves people in Medicare and Medicaid (duals) in six counties through a state-federal managed care demonstration

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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.

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Women’s Health Programs

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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

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Women’s Health Programs

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Healthy Texas Women Family Planning Program Breast and Cervical Cancer Services Income 200% FPL 250% FPL 200% FPL Gender Female Male or Female Female Age 15-44 (15-17 with parental consent) 64 and younger 18-64 Application Clients may apply by paper application or

  • nline

Eligibility determined at point of service Eligibility determined at point of service Eligibility U.S. citizen or qualified non-citizen Texas Resident Texas Resident Pregnancy Not pregnant N/A N/A

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Early Childhood Intervention (ECI)

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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.

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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

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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.

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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.

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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

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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

Big Spring

El Paso

Kerrville

North Texas – Vernon

North Texas – Wichita Falls

Rio Grande State Center

Rusk

San Antonio

Terrell

Waco Center for Youth

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

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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

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State Hospitals

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84th Legislature funded 2,463 beds across all hospitals.

Staffing trends and hospital infrastructure have reduced capacity to 2,285.

$199 $198 $166 $181 $198 $45 $68 $69 $77 $89 $27 $26 $0 $33 $18

$0 $50 $100 $150 $200 $250 2008-09 2010-11 2012-13 2014-15 2016-17

Millions Need Amount Requested Amount Funded

Deferred Maintenance Requests: 2008-2017

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State Hospitals

16 50 100 150 200 250 300 350 400 450 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

Forensic Waiting Lists for State Mental Health Hospitals: August 2008 - December 2016

Forensic Maximum Security Overall

Average Length of Stay for:

Incompetent to Stand Trial (non-max security) pop: 153 days

Civil population: 66 days

Voluntary patients: 51 days

Wait list for a maximum security unit (MSU) has been as high as 306 in fiscal year 2017 to date.

Average time spent on the MSU wait list is 169 days, but wait times can be 400+ days for highly specialized care, including multiple disabilities, social learning and rehabilitation programs.