Idaho prepares for changes to delivery of behavioral health care

The Idaho Department of Health and Welfare is gearing up for a major shift in how it provides behavioral health services, which includes mental health and substance abuse disorders.

Ross Edmunds and other officials provided an update to the Board of Health and Welfare on Thursday about the state’s move to a new managed care provider for behavioral health services.

Idaho’s behavioral health plan, which is overseen by a third-party managed care organization, has only covered outpatient services for Medicaid services. Inpatient behavioral health services are only covered under Idaho Medicaid’s fee-for-service model.

In July, Idaho awarded a new $1.2 billion managed care contract to Magellan Health, slated to go into effect in March. This organization will oversee how treatment of mental health and substance use disorders are provided throughout the state for those on Medicaid, with private insurance and without insurance.

"So it's a pretty significant change in the state," Edmunds said. 

Edmunds told the board Thursday that the division is reorganizing to prepare for this change, moving away  from providing services directly.

One of the changes will be the delivery of what’s called assertive community treatment, or ACT, which is intensive treatment, rehabilitation and support for those with severe and persistent mental illness. State ACT teams, composed of state employees with expertise in psychiatry, nursing, social work, counseling and addiction services, have been providing these services across the state.

He said the teams have been successful at delivering those services but are limited in capacity. 

"But we're stuck," he said. "We have a ceiling. Can't go above that ceiling because we don't have the staffing." 

Edmunds said many of those employees will transition to a new bureau in the division called the Center for Excellence and will coach and mentor private providers across the state, and these services will be overseen by the new managed care organization rather than state employees.

He said with the new system the state will have a single, comprehensive approach to these types of services.

Combining inpatient and outpatient services isn't a new concept. 

The Office of Performance Evaluations in 2016 looked into Idaho’s behavioral health plan and recommended including inpatient stay and improving coordination of care. In 2017, the Center for Health Systems Effectiveness at the Oregon Health and Science University did a follow-up report for the health department.

“If patients receive adequate follow-up care in the period following discharge, providers can prevent or prolong the time to future inpatient stay through judicious outpatient and pharmaceutical care,” the report said. “Idaho can integrate follow-up after inpatient care into the existing patient-centered medical home model. While not all inpatient hospitalizations for behavioral health care are preventable, future hospitalizations can be minimized through care coordination and active management strategies.”

The previous managed care organization that had been overseeing Idaho’s behavioral health plan, Optum Health, is suing the state after it was not awarded the new contract. Another organization that wasn't awarded is also suing. 

COMMUNITY HEALTH CENTERS

Edmunds also highlighted Idaho’s move to Certified Community Behavioral Health Clinics, which are nonprofit clinics that provide services such as crisis stabilization, treatment for mental health and substance use disorders, as well as physical health services. 

This year, the Legislature appropriated $12 million over two years to provide support for Idaho’s four clinics that received federal grants to start up these type of clinics.

Heritage Health, Community Health Association of Spokane — which is expanding into the Lewiston area, Terry Reilly Health Services in Caldwell and Family Health Services received Substance Abuse and Mental Health Services Administration grants in 2022.

Edmunds said the centers will work similarly to Federally Qualified Health Centers, which focus on primary care but over some other services such as some behavioral health or dental — but with the central focus on behavioral health.

The organizations in Idaho that received grants to create these behavioral health clinics, which are aimed at providing services to low-income patients in underserved areas, are also operating FQHCs. 

“It’s a really good model,” Edmunds said. “It’s good for the state of Idaho.”

The state grants are up to $1 million each year for each recipient, and there are more plans to add more clinics next year, according to the Department of Health and Welfare.

The centers are required to provide crisis services 24 hours a day, seven days a week. They also must provide treatment planning, screening and assessments, outpatient mental health and substance use services, case management, outpatient primary care screening and monitoring, community-based mental health care for veterans; peer, family support and counseling services; and psychiatric rehabilitation services.

"We're working right now on standing up those CCBHCs (Certified Community Behavioral Health Clinics), those four," Edmunds said. "That begins to provide a backbone of infrastructure for a network of services. ... It's taking away the fracture that exists and creating some stability in a network of those."