Creating Quality Coverage to Support Sustainable Recovery

Families USA2014 Health

Action Conference

Mental Health and Substance

Use Disorder Care in a Reformed

World

January 25th

Washington, DC

Need for Robust SUD/MH Services in Medicaid

Substance Use Disorders Affect 22% of Those in Medical Settings (NSDUH, 2005)

Among young adults 18 – 34, between 10% - 20% have SUD; about 90% do not receive care! (NSDUH, 2005)

About 20% of Medicaid hospital costs are associated with people with SUD

Patients with Co-Occurring MH/SUD are most likely to use ED services repeatedly and at almost twice the rate of patients with the other conditions (HCUP, 2009)

ACA Opportunities to Improve Medicaid SUD/MH Benefit

Medicaid expansion includes Essential Benefit Plan which must cover people with mental illness and substance use disorders

Adding health homes for SUD/MH

Meeting parity requirements in managed care

Components of a Robust Benefit

Public Health Approach: Screening, Early Intervention and Re-Intervention

Peer-Based Recovery Support Recovery Outcomes General Health Providers (primary care physician practices/FQHCs/Rural

Health Centers ) promote BH engagement, early evaluation & assessment, services/supports, and referral

General Medical/Behavioral Health Consultation Medical/Health/Wellness Education and related Skills Building (including

access for families and other natural supporters) Range of Crisis Services, including detox Outpatient/Intensive Outpatient In-patient and residential Recovery residence services Substance Use Disorder Medication Assisted Therapies Medication Management Care Coordination

The Likelihood of Sustaining Abstinence Another Year Grows Over Time

36%

66%

86%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1 to 12 months 1 to 3 years 4 to 7 years

Duration of Abstinence

% S

ust

ain

ing

Ab

stin

en

ceA

noth

er

Year

.

After 1 to 3 years of abstinence, fewer than half return to AOD use

After about 5 years of abstinence, only about 14% resume AOD use

Dennis, Foss & Scott (2007). An eight-year perspective on the relationship between the duration of abstinence and other aspects of recovery. Evaluation Review, 31(6), 585-612.

Over a third of people with less than a

year of abstinence

will sustain it another year

Creating Path to Sustainable Recovery

Our Proposition:

Partner with SUD and MH organizations, especially recovery organizations

Build consensus about SUD to be seen and treated as a chronic condition

Make the case that robust behavioral health benefits can save costs in the health and criminal justice systems

Offer expertise to state Medicaid officialsKeep advocating

What Happened in Georgia?

Nat’l leader in Peer Support – Georgia Mental Health Consumer Network; Whole Health and Wellness/Addiction Peer Support as a Medicaid Billable Service

Medicaid leadership willingness to engage in new ways and develop managed care approach

Strong advocacy led to M’Caid authority being invitational

Fiscally conservative leadership who want to spend less on corrections

Growing recognition of SUDs role in state costsWe are now invited to the table in a variety of

settings

How to Connect with SUD/MH Advocates

Be invitational! Recovery Advocates are in each statewww.facesandvoicesofrecovery.org www.mentalhealthamerica.net www.nami.org www.youngpeopleinrecovery.org Statewide BH Provider OrganizationsCommunity CorrectionsRecovery Community Organizations

Voice of the lived addiction recovery experience should be at every table

Express that addiction and mental illness are public health issues and a public health approach should be taken to address them

Dennis, M.L., Foss, M.A., & Scott, C.K (2007). An eight-year perspective on the relationship between the duration of abstinence and other aspects of recovery. Evaluation Review, 31(6), 585-612.

AppendixWhat does recovery look like on average?

Duration of Abstinence1-12 Months 1-3 Years 4-7 Years

More social and spiritual support Better mental health Housing and living situations continue to improve

Dramatic rise in employment and income

Dramatic drop in people living below the poverty line

Virtual elimination of illegal activity and illegal income

Better housing and living situations

Increasing employment and income

More clean and sober friends

Less illegal activity and incarceration

Less homelessness,

violence and victimization

Less use by others at home, work and by social peers