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 1/5th 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 services ONlY

• Residential tx
• Social detox
• Transitional housing
• Case management
• Psychiatric services
• Vivitrol

Partially funded by Medi-Cal*

• Outpatient
• School-based
• Medication assisted treatment
• Perinatal Outpatient

* Selected services are reimbursed for these modalities

OP & AMT –Medi-Cal, County General Funds and Other Payors

SUTS Modalities General fund dollars MediCal Realignment Other payors Total Cost 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 – Limited to pregnant, parenting women, opioid addiction Eligibility- Expanded to single, childless adults Eligibility- No change Modalities- Perinatal, Addiction Medicine, OP Modalities- Perinatal, Addiction Medicine, OP Modalities- Includes detoxification services, residential, recovery services, case mgmt Reimbursable services- Assessment Crisis intervention Discharge planning Grp tx Intake Reimbursable services- Assessment Crisis intervention Discharge planning Grp tx Intake Expansion of services to include services under the above modalities and bed days for residential tx

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

28 30 34 28 28 31 31 35 33 33 30 31 20 40 60 80 100 120

Figure 1. MediCal clients as a percent of monthly admissions (FY 2015)

MediCal (C50) Other Payors

MediCal Payor at Admission for OP & AMT only – FY 2015

31.3 35.3 38.5 34.1 38.4 43.9 42.3 47.4 45.1 44.7 42.2 43.6

Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15

FIGURE 2. MEDI-CAL AT ADMISSION - OP & AMT FY 2015

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

Race & ethnic composition of treatment population

Racial and ethnic minorities make up the majority of the clients admitted to treatment in FY 2015 Total admissions FY 2015 = 8247 Minority clients accounted for 66% of admissions during 2015 Hispanic/Latino clients made up 48% of admissions,

Hisp/Latino, 48 Native Amer, 2 Asian/PI, 7 African-Am, 8 Mixed/other, 3 White/Cauc, 34

Figure 3. Race/ethnicity at admission to SUTS tx services (FY 2015) n=8247

Age and Race-ethnicity of clients at admissions to SUTS Tx - FY 2015

 Latino-Hispanic clients made up

the majority of clients under the age of 34 years

 78% of youth were Latino-Hispanic

 White clients made up the majority

• f older clients (50 years and
• lder)

 Medi-Cal eligibility changes had the

largest impact on single adults

78.0% 54.7% 48.1% 50.7% 49.0% 45.7% 38.8% 26.3% 33.6% 36.7% 9.5% 29.0% 33.2% 30.8% 31.4% 36.4% 42.9% 51.9% 44.4% 37.7% 0.0% 20.0% 40.0% 60.0% 80.0% 100.0% 120.0% Under 18 yrs 19-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60+

Figure 4. Age and race/ethnicity at admission to SUTS tx services (FY 2015) n=8247

Hispanic Native American Asian/PI African-Am Mixed/other White

Gender distribution at admission to SUTS –FY 2015

Single, males made up most

• f the admission

 The majority of clients admitted to

SUTS were men (67.7%)

 Women made up 32.2% of

admissions

 Clients of “other’ gender made up

0.2% of admissions Figure 5. Gender distribution – n=8247

32.2 67.7 .2 Female Male Other

Paid employment in past month – FY 2015

 At admission, 82% reported

having no paid work days in the previous month

 9% worked at between 1 and 15

days

 7% worked between 16 and 29

days

 Only 2% worked for 30 days  Profile of a population in need of

safety net services

82 9 7 10 20 30 40 50 60 70 80 90 1

Figure 6. Paid employment in 30 days before admission - FY 2015

No paid employment 1 to15 days 16 to 29 days 30 days

Where our clients live

33% did not provide a zipcode- most of these clients are homeless 14.9% came from East San Jose 13.8% came from South San Jose 9.9% came from West San Jose 9% came from Central San Jose 6.9% came from south county

32.7 14.9 13.8 9.9 9.0 6.9

Figure 7. Client zipcodes at admission-FY 2015

No zip SJ-East SJ-South SJ-West SJ-Central South Cty Santa Clara Sunnyvale SJ-North Campbell NE Cty Mountain View Other cities

Primary & secondary drug at admission-Methamphetamines & Alcohol

Methamphetamines was the primary drug in 43.6% admissions and the secondary drug in 13.4% admissions Alcohol was the primary drug for 24.8 % in admissions and secondary in 16.6 % of admissions

0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0 45.0 50.0

% of admissions

Table 8. Primary & secondary drug at admission- FY 2015

Primary Secondary

Comments & Questions

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