Medicaid Innovation in Improving Access to Behavioral Health Care
Thank you so much for joining us for today’s panel discussion. My name is Allison Hamlin. I’m president and CEO of the Center for Healthcare Strategies or CHCS and I’m honored to welcome you to today’s panel. Medicaid innovation and improving access to behavioral healthcare. Strengthening behavioral health services is a top priority for Medicaid agencies across the country. At CHCS, my colleagues and I have spent decades collaborating with state agencies, managed care organizations, and providers to find more effective ways to increase access to highquality person- centered behavioral health care across a continuum of settings. Today, we’re so excited to hear directly from three state Medicaid leaders who are rolling up their sleeves and making real progress to transform their state’s approach to behavioral health service delivery. They’ll share what’s working, what’s challenging, and what others can learn from their experiences. Next slide, please. Before we dive into today’s agenda and introduce our panel, I’ll provide a brief background on CHCS for those of you who don’t know us. CHCS is a national nonprofit that works to strengthen health care services to ensure better, more equitable outcomes for people served by Medicaid, particularly those with complex health and social needs. We partner with state and federal agencies, health plans, providers, community- based organizations, and community members to address obstacles that stand in the way of better care and improved outcomes. Our work advances more effective models for care delivery, more efficient policy and program design, and ultimately better outcomes. Next slide, please. So, let’s dive into today’s agenda. I’m going to start us off with a brief overview to set the stage covering key background on Medicaid and behavioral health. Then, I will introduce our fantastic panel of state leaders. We’ll spend most of our time today hearing directly from them about the innovative state specific strategies that they are using to improve behavioral healthcare and we will be sure to leave some time at the end for audience questions. So feel free to drop your questions into the Q&A tab at the bottom of your screen at any time during the event. We may not get to all of them today, but your input will be helpful in shaping future conversations. Next slide, please. As many of you know, Medicaid plays a critical role in financing our behavioral health system. Medicaid is by a significant margin the largest payer of behavioral health services in the country and thus has an outsized opportunity to drive system change across a broad continuum of mental health, substance use disorder treatment, crisis response, and recovery support services. Next slide, please. Despite a number of advances over the last decade, our behavioral health system is significantly underresourced compared to the need for services. Only half of adults with mental illness and fewer than one in four adults with substance use disorder receive treatment for their conditions. Notably, these gaps are not evenly distributed. While there is a widespread provider shortage, rural and underserved communities experience this shortage most acutely. More than half of US counties have no practicing psychiatrists and threearters of counties are designated mental health professional shortage areas. Accordingly, instead of being prevented or treated early, behavioral health needs often flow downstream to emergency departments and even to the criminal justice system. Next slide, please. Unmet behavioral health needs contribute to a range of negative outcomes, including preventable deaths that impact families and reverberate through our communities. All of this leads to greater strain on Medicaid, on hospitals, and acute settings, as well as other public systems like child welfare, housing, and corrections. In the current Medicaid environment where it can be hard to think about where is money going to come from to invest in expanded access to services, it’s so critical to remember that as a society and as taxpayers, we’re already paying the cost of unmet behavioral health needs in so many low value ways. Next slide. Fortunately, state Medicaid agencies and their behavioral health partners hold many powerful levers that can be used to redirect funds toward higher value care across the continuum of need. For example, there are evidence-based models for integrated behavioral health in primary care and certified community behavioral health centers in specialty settings. There are innovations in payment models, effective ways to leverage managed care contract requirements, workforce innovations, and cross- sector partnerships that can blend and braid resources in more streamlined and strategic ways. Today we’re privileged to be joined by leaders from Colorado, Massachusetts, and Wyoming, states with both rural and urban geographies who are using these levers as part of comprehensive approaches to reimagine and expand behavioral health access for Medicaid Medicaid members. They’re using data to identify areas of need, measure progress, and to hold themselves and their system partners accountable for delivering more and better care. Next slide. So without further ado, I am so pleased to introduce our speakers today. Each of them is a leader in behavioral health reform within their state’s Medicaid program. They are deeply committed to improving behavioral health outcomes and advancing the well-being of individuals, families, and communities across their states. First, Kristen Bates is deputy Medicaid director and director for behavioral Colorado behavioral health initiatives at the Colorado Department of Healthcare Policy and Financing. Lee Robinson is associate chief for behavioral health at the office of accountable care and behavioral health for Mass Health in Massachusetts. And Lee Gman is senior administrator and state Medicaid agent, aka the Medicaid director at the Wyoming Department of Health. Before we get into the discussion, please indulge me for for a moment as I note two firsts here for a CHCS webinar. Number one, this is our first time featuring two panelists namely. I will do my best not to confuse them or you or myself as I moderate our discussion today and thank you in advance for your grace. And two, I also believe this is the first time where all of our panelists are alumni of CHCS leadership programs, including both the Medicaid Pathways Program and the Medicaid Leadership Institute. It is so incredibly comforting and inspiring to know that some of our best Medicaid leaders across the country are devoting themselves to improving access to behavioral health services. In an otherwise tough season for Medicaid, this is excellent reason for hope. And with that, I welcome our panel. So nice to see you all. Well, we are going to uh get into it here. I think we can um bring the slides down and uh and focus on everybody’s faces. Thanks again for joining us. Um and I’m going to start us off today um with uh some some highle questions to sort of frame the discussion and and to jump right in there. Um just to acknowledge that um every state comes to these issues with their unique context. Um you have common tools to work with across your states, but the problems you’re trying to solve can vary and the landscapes you’re the landscapes that you’re operating in have their own unique challenges. So, I’m going to ask you each to start by sharing the core vision behind your state’s efforts to expand behavioral health services to meet members needs and to talk about the key challenges you were attempting to address and where you focused your efforts. And so, Kristen, I’m going to ask you to kick us off. Welcome. Thank you so much, Allison. Thank you everybody for making time to talk about uh my favorite topic, behavioral health Medicaid policy. Um, and I I’m here in Colorado where we have a managed care uh behavioral health Medicaid program and uh feif for service physical health program. So that’s kind of our structure. Um, back in 2019, our governor, Governor Jared Polus, created a behavioral health task force. He called on all of our state agencies, you know, transportation, agriculture, you know, obviously the health agencies, human services, um, and really wanted to understand why Colorado was a top five state for physical health and a bottom five state for behavioral health. Um, we had a very neglected and complex payment system. So that really drove this this scarcity mentality um among our providers and our members where a number of our key stakeholders were deeply committed to status quo if it benefited them if they were um some of the few uh who were getting strong contracts or those who were afraid of losing out on what had been historically limited funding. So, we knew that change was going to require a strong central infrastructure. Um, partnership with local communities. We had to rebuild some broken trust um between patients and families and the state. Um, we had to come up with some new ways to pay for care that were somewhat affordable. And we also saw there was deep stigma um uh self stigma, infrastructure stigma, provider stigma uh kind of at every corner that we turned. So our goal that we set, our vision was fairly simple. Timely access to quality behavioral health services. And that sounds simple, but each of those words can be measured. Timely access and quality, right? That’s the way that we measure and and track ourselves on are we making it. So, we had been working in the past, which much more on like that kind of whack-a-ole kind of style or whack-a- lawsuit, if you will. Um, and that was where every year the legislature would take on one or two problems that were key headlines, uh, had maybe led to some catastrophic outcomes, um, and try to fix that exact problem. So we really had to work with this foundational task force to say we want to identify some achievable areas uh some achievable actions in every single area. Access, affordability, workforce, community partnerships, social determinants, and we created 19 priorities to get through kind of an a few goals in every single one of those sections. And then we published that plan, that blueprint. And the blueprint was the key to the last pillar which was accountability. Um, and I think that was one of the most essential things we did is we really created accountability within our state infrastructure within uh within the governor’s office as well. And so we all know that diffusion of responsibility can really be a death nail in complex policy. Um because when something is everyone’s problem, it’s nobody’s problem. So that’s where we started. I’d love that. Um, you’ve laid out so many so many places for us to dig into further, Kristen, so thank you for that. Um, and to keep things um at the sort of vision level at this point. Um, Lee from Massachusetts, I’m going to turn to you. Um, so Colorado has its blueprint. Massachusetts has its roadmap. Um, you’ve been at this for a little while now. Um I think you’re about two and a half three years into implementation and would love for you to sort of kick us off with um you know the the the vision, the goals, the you know early you know early insights from your process thus far. Yeah, thank you so much. Um and I’m going to steal Wacka lawsuit uh now. Um, so I think it’s going to echo a lot of similar themes to what Kristen was saying, but I think that um, even before COVID, I think there was a real sense in Massachusetts that um, despite having a relative wealth of behavioral health clinicians and resources. Um, things were not making sense and people were not connecting to care and there was something fundamentally broken. Um, and I like Kristen’s analogy of kind of peacemeal approach is is not necessarily the best way to build, you know, a functional house. Um, and so we uh had a formal launch of our roadmap for behavioral health reform in 2023, but in the years leading up to that, our state really took an intentional effort to do as many different listening sessions as possible all throughout the state um to hear from uh individuals, members, families, and other um important uh system partners to hear straight from them what is broken about the system that we’re all kind of experiencing as broken. And so where should we focus our efforts? And um over 700 individuals were able to participate in those listening sessions. Um and while there was a lot of different feedback, it was all relatively consistent along a few themes. One theme uh is that too many people could not access care um in a timely way that was accepted by their insurance. And again, this is despite us having a relative wealth of resources. Um, another consistent theme was that the emergency room was the only reliable point of entry for people experiencing significant behavioral health needs. Uh, another theme is that uh despite our our best efforts, we had a fragmented substance use disorder and mental health system. And so for individuals uh struggling with both issues, which is honestly the rule more than the exception, um they often times struggle to find care that met all of their needs in one location. And then I think um connecting with uh culturally competent care, care that was um meeting folks uh cultural needs and wishes was just very difficult to access. And so out of that was born the the roadmap for behavioral health reform. And there were several goals uh within that and I think they they directly tie to to the the feedback that we heard. The first is that we needed to establish front door access to care. Um and front and act care meaning integrated mental health and substance use um coordinated uh across all of the the system partners, culturally competent and across the lifespan and across the state. Uh we also needed to establish that same high quality care for members with ongoing behavioral health issues and complex behavioral health needs. And hopefully with those two um first two goals, we could ultimately prevent people from going to the emergency room, which uh Massachusetts uh in the years preceding 2023 were, you know, similar to a lot of other states in that we really had an ED boarding crisis um where there were a lot of people in our emergency rooms waiting for for critical behavioral health care. And so with those three goals um in mind, there was a number of different initiatives that were part of the behavioral health roadmap. Um, one of them was establishing a statewide network of community behavioral health centers. And so we have 27 CBHC’s across our state. And while Massachusetts is not a CCBHC demonstration state, our CBHC’s surprisingly look very familiar to the CC BHC’s. Um, and so we have 27 CBHC’s with 27 catchment areas across the state. And um in part of that um umbrella CBHC program in each of the 27 areas there is a clinic which again looks very similar to CCBHC clinics. There’ll also in each of those 27 catchment areas there’s adult and youth uh mobile crisis teams which are embedded at the the CBHC clinics. And there’s also access to adult and youth community crisis stabilization or kind of 24-hour um non-lock diversionary bed access for youth and adults. Um and so the CBHC’s really are the brickandmortar front door. They are open, you know, there’s 24/7 access uh across the board um across the state for brickandmortar access to care. Um at the same time, the state set up a behavioral health helpline. And so if the CBHC’s are the brickandmortar front door, the be behavioral health helpline is the virtual front door. And so this is a helpline that’s available 24/7, payer agnostic. You know, anyone can can call, text or chat um to access behavioral healthcare and they will be able to speak to someone who can clinically assess their needs. And more than just being given a list of phone numbers, they can actually have a warm handoff while they’re still on the phone with a CBHC um program and CBHC clinician. Um, additionally, uh, we knew that we needed to, you know, expand access across more than just the 27 CBHC’s. So we also started a process in which we’re trying to shift um our large and diverse mental health center network more into kind of a population uh uh population health um system that is able to meet people’s needs in a flexible way. And so we created a network of behavioral health urgent care clinics which are basically mental health centers that have extended hours and flexible uh timely access to care. Um and then the last thing that I’ll mention is to support all of these initiatives, um we are fortunate to be able to stand up a behavioral health workforce training clearing house. And so basically instead of kind of having all of these different entities try to tackle um kind of training and uptraining um to to meet the goals on their own, we established a central kind of node of evidence-based um training both live and asynchronous that can provide uh evidence-based training to all of the clinicians that are working in all of these different elements of the road map. Um and so uh multi-pronged approach to hopefully um provide folks with access to care both brick and mortar and virtual and to keep people out of the emergency rooms. Thank you so much, Lee. That’s uh such a great summary of the multiaceted way that um you’ve been approaching this transformation um in Massachusetts. And Lee Gman, I’m going to turn to you to um lay out the the vision and the and the goals for Wyoming in these efforts. Yeah, thank you Allison. And just before I jump in, I’d like to thank you and the CHCS team for the opportunity to share a little bit about the work in Wyoming and and also to my uh fellow panelists for um this conversation today. So, similar to some of the other states, you know, we’ve we’ve had an initiative here in Wyoming that’s really started at the top. Um Governor Mark Gordon’s uh initiative which is called Why We Care. If you look at Wyoming initiatives very long, you’ll see that we use that WY um uh abbreviation for a lot of different things in terms of branding. Uh so, a little bit about that and and how we’re affectuating that across not just Medicaid, but our Department of Health enterprise really the problems and the and the guiding vision for us is access to quality services and reducing stigma. Those are two of the really key things um for us that start with the governor’s office as well as uh as those of us in leadership roles. Um if you don’t know much about Wyoming, you probably know that we’re a very low population and geographically large state. Um so just to give that a little bit of context, there are less than 600,000 of us uh located across again a very large state. Um so the classic saying here is we’re a small town with very very long streets. And so the way that we try to um really leverage this in in terms of just the culture of the state, you know, high degree of independence that people want and and uh have a lifestyle of here in Wyoming, while also making sure that it’s okay to check on and help your neighbor essentially is really a lot of what we’ve been leaning into both in from that stigma perspective in terms of outreach and just how we approach this um I think as as leaders as well. Another very unfortunate um fact that we have here in Wyoming is that we are often at the top or very close to the top in national rankings in terms of our suicide rate. Um that’s something that Wyoming I especially those of us in the health uh area um know intuitively or policy makers know intuitively and frankly it’s a it’s a fact that we’re uh that we’re not proud of and and want to try to uh want to try to do better in that space. So those are really a lot of the the both the guiding principles but also just the problems that we see that we’re trying to solve. Like I think so much of us experience you know we we hear when we engage with folks about fragmented system access to services especially in a highly rural um or frontier setting is so difficult. So what we really focus on is how can we best leverage the infrastructure and healthcare expertise that exists because it’s so much more effective in in our experience to do that than to try to build something new in a very again small or perhaps even isolated uh community. So what that has really looked like in the initiative that um that I just like to highlight when we think of sort of our flagship vision and and effort here is uh something that we have called a behavioral health redesign. Um, and what this is essentially is a culmination of many years of conversations uh with uh with several legislatures that has really built uh to a legislatively uh mandated change that long story short has involved our community mental health centers uh really reforming just the nuts and bolts of how they do business to where this is and and just keep in mind that this is of course a non-Medaidf funded system uh traditionally to where that system for everybody who walks in the door uh needs to be assessed for Medicaid eligibility and they now also bill and get reimbursed through our Medicaid infrastructure. Um so that’s something we’re very proud of in Wyoming of the enhancements and modernizations that we’ve made for just how we enroll providers, pay claims, all those fun things that you and the Medicaid space know about. Um really leveraging that to where that’s how uh that’s how our our community mental health centers get paid, etc. And what that does is has helped sort of fill a data vacuum where oftentimes, you know, as state leaders here in the department, we would be asked for services that are being delivered in terms of just the types of services, who’s receiving those, um, and what that looks like. And those have been difficult questions to answer. So, this is giving us some of the data and the insight to be able to do that. Um, so that’s just a little little bit of teaser that I’m sure I’ll get into a little bit more. Uh but that’s a very cross agency effort where we’re really able to show how Medicaid can be a good partner again across the healthcare delivery system uh in Wyoming. Lee, thank you so much. And um I’m uh so pleased uh that we have the the array of of states and environments and challenges represented here because it just it highlights so much of how important the context and the landscape really drives the um the goal setting, the problem definition, the you know the resources that you have to work with and the areas that you focus on. And um I think collectively you represent so many strategies of relevance to our audience. So, um, so thank you again for your willingness to be part of the conversation. Kristen, I’m going to come back to you, um, for a moment. One of, you know, one of the things we’ve been, um, particularly interested in watching develop as part of your efforts in Colorado are the major investments in infrastructure for behavioral health services. Um, can you, um, talk about, uh, how this came together? um how you’ve worked um across state agencies to fund this um you know pretty significant investment in behavioral health infrastructure um and um any results that that you’ve been observing um as a as a result of your efforts. Yes, thanks again Alison. Um so in Colorado we had this task force that was like 2019 2020 we put out the results and um we had some really great momentum going right for major reform and we had all these state agencies lined up. We had created this new state agency called the behavioral health administration uh that has its own commissioner that reports directly to the governor. So, a new cabinet level position. Um, and we had all these groups who had worked really hard to prepare this blueprint. Uh, uh, similar to Massachusetts, we had a thousand different people come and testify. Um, like many people, I have personal experience with them uh, as family member of somebody loving somebody who uh, faced addiction and is living in recovery now. But I was the first one to to give testimony, right? Like we all gave testimony. We’re testimony from everyone. So, we had this blueprint. We were so excited, but we were scared because we thought it might take us 10 years to accomplish all of these things. Well, then COVID came and shortly after the CARES Act or the CARES Act and then the American Rescue Plan Act and all of a sudden we had all this relief funding and we were really well positioned because we had a plan. We had a plan that was stakeholded. We had a plan that was wellformed, that was researched, that was evidence-based. So we could come with, oh, you’ve got funding, we’re ready to take it on immediately. And that was really attractive in those days if you all remember what it was like in 2021 when the legislators were at the state level really giving out a lot of funding. So we had about 150 million from our Medicaid funds um Medicaid relief funds and we had about 550 million um in state relief and so we took off as fast as we can with that. So our main activities um required significant policy change right and CMS approvals. So we were running as fast as we could and everyone was like why aren’t we seeing it? Why am I not feeling this big reform that you keep talking about? And it was really difficult to maintain trust and keep patience at that time. Um so we really worked on a number of activities. We had new provider types. Uh that was a really big part of it, redefining providers, similar to Massachusetts, right? We uh created workforce programs. We had a big provider recruitment campaigns to get people into Medicaid. Um we also wanted to really dispel all these old ideas about what it was like to be a Medicaid provider and how it was too complicated. Um we had a lot of peer uh partners help with that. Um we did an entire new regulatory set of standards for all of our behavioral health providers. That was a big one. We expanded benefits, especially in substance use. We had a new 11:15 waiver. Um, and we had hundreds of millions in these provider grants. So, we were really holding our community to a new standard, but we had to give them funding to get there. So, the so the so the pairing went really well in that respect. So, with all that motivation, all that funding, it took about four years for us to see systematic results. So every year we were, you know, crossing our fingers the number coming in and we were like, “Oh, we’re still not seeing it.” But once we started seeing it, it came fast and it came strong. So, um, it wasn’t just government administration. Like we were making a difference. We had we went from just about 6,000 uh, behavioral health contracted providers in managed care to, uh, almost 14,000. So more than doubling the number of providers that entered into the system. Uh, we had new benefits. We had some legislative funding that came in, but in managed care, a lot of the funding gets built into the budgets over time based on the past year’s utilization. So every time you make an effort to increase utilization, that gets gets built in over time. So we went from about $600 million and in Colorado we have about 5 a.5 million people, 1.3 million on Medicaid for context. We went from about 600 million to 1.2 billion. That was uh this past year’s budget for behavioral health. Um so we had more than doubled our state Medicaid investment. And then the big one for me is we had a 41% increase in access to care for Medicaid members with behavioral health needs. Like that is the number that really knocked me out, right? Um and so that’s not inflated by PHE volume. That’s the total amount. Now, somebody immediately asks in the Q&A, “What are you all doing for the reconciliation bill? And how are you preparing for cuts?” The challenge now is we’ve built all this in. Now, we need the growth to plateau. So, we’ve hit our numbers. Now, we need to make sure that we don’t end up with an exponential curve here. um in a year when we are facing obviously major state and federal budget limitations. And just to you know uh pause for a moment and just congratulate um the state of Colorado on the incredible performance. Um you know those those numbers are astounding and they’re worth celebrating. So, um just really kudos and I see all the um icons and emojis in the from the audience and it really um that is not easy to do. Um and um and I I love your point about um being ready to capture the moment. um we don’t get those moments of, you know, having um ample resources to, you know, fund those types of infrastructure investments all the time, but having the plan at the ready to take advantage of those moments when they do appear is um is just critical. Um so, um we’ll dig back more into this, but I want to turn um back to Lee Robinson in in Massachusetts. And um you know, I I alluded to this before. Um I jumped the gun a little bit in my question, but again thinking about sort of lessons learned um now that you’re a few years into the implementation of the roadmap, what you laid out initially was, um an incredibly ambitious set of goals um and massive reforms to the system. Um and curious how it’s been going. Um you know, have you been able to um achieve the goals that you set out there? what have what have you learned along the way? And again, for um audience members who may be earlier in the process of um developing goals, you know, charting this course, what sort of words of wisdom would you offer um with a few years of implementation behind your belt? Yeah. No, thank you so much for the for the question. Um and I I can assure you that moving from the planning phase into the implementation phase is way harder. Um, it’s it’s it’s a lot easier to plan these things than than to actually implement them. Um, I think I would theme my response by saying behavior change is hard. Um, and I know that that is uh kind of like a no duh type statement, but I think it it kind of sums up everything that we’ve been dealing with over the past two and a half years. Um, I think that, you know, so much of the the change and the initiatives that we put forward really is about allowing people to change and that’s very different than actually having people change. Um, and I think that uh I don’t think it’s actually possible to underestimate the gravitational pull back to the status quo way of doing things. Um and to you know to actually fulfill the potential of having real change happen it requires a lot a lot a lot of active um blood sweat and tears honestly. Um and so in the theme of kind of behavior change is hard I think that you know we we see this and we have seen this across the board across our system. Um and so at the provider level to start, you know, and thinking about outpatient behavioral health providers, um who are newly operating in a new kind of clinic or a new type of service model, um emergency rooms, inpatient hospitals, uh folks who are are going to be uh referring into, you know, these these this this new system and these new services. Um we’re 2 and 1/2 years in now and despite a lot of marketing, a lot of meetings, a lot of presentations, um we even did like speed dating uh protocols in which we like literally put emergency room staff in the same room as the CBHC staff and like locked the we didn’t actually lock the doors, but like we basically said like you can’t come out until you know each other and exchange contact information and have developed actually workflows for, you know, getting getting people seen. Despite all of that, um I I still I’m I’m a psychiatrist. I still do a half day of clinical work. And to this day, I still talk with people clinicians in the state that have still not heard about a CBHC. And so my forehead is very dented from hitting hitting the the the desk. Um and I think that the other um you know level that’s worth mentioning as far as behavior change is hard is on the payer side of things in the sense that you know this is you know behavioral health forever has been a fee for service pay by the widget type of of of program and to shift even a little bit towards a more population focused payment model that uh is not necessarily paying for a widget but paying for the costs of providing access to a population. Um, that is really a nuance thing to get people on board with. Um, and you know, even people who were very much on board now that we’re two and a half years in and they see on the claim sheet a cost that’s higher than the fee for service cost, they’re they’re it’s hard to to make that leap of like what are we getting for that extra amount? Um and so I have a list of four uh pieces of advice that I I wish that you know we had received um uh earlier on. Um so the first one is very very very frequent and insistent expectation management and goal reminding. So, it’s constantly important to be reminding people about the goals that we collectively, everyone as a state signed up for um to remind them that this is a shift away from kind of a status quo, away from um uh kind of a widget-based model and and towards a a population health model. And also that, you know, the the level of change that we’re talking about here is not a one-year return on investment. um and that this is a a um a a largecale change that’s going to take many years and you know we have to be in it to win it and and reminding people about all of the problems that we had before we went into this uh that drove the goals that that we’re trying to achieve. Um the next big piece of advice is data. And I think we’re going to talk about that a little bit later, but I can’t say enough about the importance of getting all of your ducks in a row as it relates to data and where you’re going to get the data and how it’s organized and and how you’re going to be using that data. Um, the third piece of advice I would say is is, you know, in that gap between allowing people to change and actually seeing change is, you know, what we call network management. basically like being at the elbow working with providers uh and really supporting the behavior change and supporting the adoption of the model all throughout the way. And this is where we’ve been very fortunate. We have um a behavioral health managed care vendor in our state and we’ve been working with them who’s been working, you know, really at the elbow with all of our CBHC providers, you know, every week um to really support the the newer focus on access and the change from kind of the typical, you know, group practice model of outpatient behavioral health and also, you know, where we need to actually holding providers accountable to the model through performance improvement plans and and and things like that um and then the last thing I would say is that uh you know behavior change is is hard enough but in health care uh particularly when we’re talking about the crisis system it’s it’s really really hard if it’s not payer agnostic um and you know when you’re talking about like an emergency room and I feel like I could say this because I have emergency room friends um they can’t learn six different dispositions for six different insurance products they want to learn one disposition that works for all the insurance agents. And you know, we heard very early on that, you know, if there was any chance that a CBHC couldn’t see this member based on their insurance, they weren’t going to refer anyone to the CBHC’s. And so I, you know, and I’ve heard this from some some um some colleague states that have, you know, pursuing similar models that the commercial side of things and making sure that everyone can access these services is just so essential. And so, um, we’ve been fortunate in our state that we have a really, um, supportive legislature that have, uh, put in place some legislative requirements around coverage across all payers for CBHC services. And it allows us to to really build these services as payer agnostic in a way that if we weren’t able to say that, we would just lose half of our audience um, in in in kind of trying to sell the story. Um, so happy to talk more in detail to any state that’s interested to hear more about those, but those are kind of the four big buckets. That’s great. Um, always love a good list, Lee, and that was um, terrifically insightful. Um, and you know, just thinking about, you know, the the leverage that Medicaid has in behavioral health. you know, as um you know, I talked about at the opening here, it in the case of behavioral health, Medicaid is the predominant payer and um exercising that leverage to bring other payers to the table. Um it, you know, can be more feasible in the area of behavioral health than it um may be in other areas of health care. Um and so just really appreciate those points. Lee Gman, I want to turn to you um in Wyoming. And one of the things I’d love you to speak a little bit more about um is the cross agency um effort that you’ve been a part of um in addressing these issues in the unique environment um and with the you know specific goals that that Wyoming has here. So can you tell us um a little bit more about um in particular how um how those that collaboration has come together? um how for example you’re working with other agency partners to think about the connections between behavioral health and health rellated social needs for example. Yeah, that’s a great question. Happy to speak more about that. So the uh the initiative I I referenced earlier um again is really trying to solve what is not exclusively a Medicaid issue, right? We’re talking about access to behavioral health services, especially through our community mental health centers, and focused here acutely on some of the most high needs populations. And when I say that, I’m thinking of folks who are in jails um or at our state hospital or on our waiting list to go to our state hospital. So those are sort of the key metrics for success that we’re focused on and rallied around across uh across state government is how we can reduce recidivism and uh decrease the times spent on our weight list for our state hospital. So our partners in doing this are uh in addition to just a we’re a large umbrella health agency. So for example our state hospital behavioral health administration we’re all under that umbrella. So in addition to those partners also the department of corrections uh department of family services who is our you know adult and uh child welfare services and then also the court system has been a big partner here. So with all those entities that includes our cabinet level secretaries uh you know deputy leaders etc. Uh but that’s even included uh legislative leadership and also the uh supreme uh supreme court chief justice. Uh so very visible, a lot of lot of leadership to help drive this priority. What that looks like in terms of really again focusing on that highest need population uh as a part of this reform effort, which by the way is is just a year old. So we’re still learning. Please please know that we’re still uh uh we’re not the experts and I don’t have these amazing metrics that Kristen had to support in terms of of success. We’re throwing things at the wall and like I’m sure so many of you figuring out what sticks here. Um but the concept that we are providing here and really trying to prove is for some of this most these most acute uh folks think of those transitioning out of jail transitioning out of our state hospital um that’s really what we’re focused on in terms of making a quote unquote priority population. So what this means is when someone is transitioning out of one of those settings, uh we connect them with resources uh again in the community where they’re going to and are looking at these outcomes based payments. Is the person housed? Is the person employed or otherwise meaningfully engaged uh you know with a with an opportunity in their community? These really sort of you know basic overarching policy goals that are widely shared across uh across the state and and tying money to that. So, for example, if a community mental health center is invested in providing that type of support and can show those outcomes, there’s additional payment that uh that goes um that goes to that entity. Um and that was a really big thing for our legislature in terms of passing this reform is they wanted to see that level of investment and that focus on outcomes. So what we’re seeing just in the first year of this um just from our data in terms of who that priority population population is is the vast majority are folks transitioning out of uh an aarceral setting. The smaller number that we’re seeing um but still seeing you know again significant populations or be referrals from our court system. So that could be diversionary for example or or from uh for example our department of folks who are transitioning from our state hospital. Um so still doing a lot of learning in terms of that concept but we’re really just trying to essentially pay and tie those dollars to the things that we have broad policy agreement uh that we want to see result from from our involvement and support with these folks. That’s amazing, Lee. Um, uh, I’m I’m sure there are many members of our audience that would love more details on those outcomes based payments and so we can work with you to figure out a way if there’s, you know, more, uh, links to share and, uh, to the extent we can identify that, we’ll be happy to to pass those along because I’m sure there are any number of folks who would like to replicate that really thoughtful work. Um, and as Kristen has noted, it can take five years um, for, you know, for the payoff to be obvious. So, you know, keep telling your stakeholders, you know, we’re only we’re only a year in. It it takes time. This is um these are these are major major system reforms that um that are worth playing out for sure. Um Lee, you were just talking about kind of the tip of the spear um some of our um most complex um members and the you know, highest constellation of needs. I want to bring us back out in the pyramid um to the base um of of the pyramid for a moment and talk about prevention and how you all are thinking about um kind of the full continuum um of care here as as you’ve all spoken to in some of your earlier comments. Um Kristen, I’d love um to turn to you first um to hear a little bit about, you know, where sort of prevention and um early intervention fits into the model that you’ve been working on in Colorado. Yeah, thanks Alison. And as a my background is in public health, so I always have to answer this question kind of twofold with the primary prevention early intervention and then with the secondary prevention program. So, um, for primary prevention, early intervention, we took some of our ARPA funds and we ran a are running a $30 million primary care integration program. Um, so we have over 180 sites in Colorado who uh who are receiving these funds. And honestly, one of the things we did was we made the application really simple. Like we said, here are the five evidence-based programs that you can use. Tell us which one you’re going to be using. tell us about your patient panel. We didn’t have some super complex. We wanted it to be accessible so that people could start the work because there people were so eager for this. This was one of the easiest bills I’ve ever gotten past, right? Like it was everybody just high-fived like all the way through. Everybody loves the primary care integration. Um so the funds really paid for training, workflow redesign, uh billing and operations. We allowed for infrastructure changes. Um, and the goal is really to better serve, especially in rural areas where you don’t have behavioral health providers at all, but also to serve people who need more of that screening, early intervention, identifying folks who need those services, and then of course some medication. So, um, then the other thing we had to do was create a sustainable model. So, we actually opened up some of our new codes, the um uh specifically collaborative care management codes and as well as and I’m going to get in trouble for not remembering what uh HBAI codes stand for, but we opened new codes in our primary care setting. We also um made it part of our fee for service kind of physical health um and kept all of our psychotherapy in our managed care space. So really what we’re paying for is not that the psychotherapy is under that managed care behavioral health. This is more a service that uh gets more access to folks. So that was really exciting. Last week I got the best email ever from a grantee. Hey Rachel, our project manager. Uh we have no expenses this month because we’ve been able to cover all of our services with Medicaid. So, that was amazing that we’ve been able to take that, create a new policy before the grant ended so that it eases our grantees off so that you don’t have that abrupt stop. Um, for secondary prevention, that’s kind of like creating these specialized benefits for folks we know with complex needs to keep them out of hospital, to keep them out of institutions. So um these are really focusing on incentivizing intensive outpatient transitions and inhome clinical services. So for youth and children we are implementing a system of care. So we just started July 1st um with um high fidelity wraparound inhome family supports. We’ve expanded our home and community based services uh for children with uh developmental disabilities to also include serious emotional disturbance which is a big one because you get that psychosocial family training in there. Um and then we also set up uh uh an expansion for mobile crisis along with a new system called behavioral health secure transport. So those programs are designed to serve people in the community, transport them without law enforcement engagement and without emergency department engagement. So that’s not just about it’s about preserving community resources as well as using our Medicaid behavioral health resources. The mobile crisis is pay agnostic. Uh secure transport is not. It is really a Medicaid truly a Medicaid service. Um the Denver version of this, some people have heard of this. It was called the STAR program. Their first year that they expanded their mobile crisis so that it was truly more of a clinical mobile crisis response, they had zero arrests for a year um among people who called with a behavioral health crisis. That’s a big deal. So that’s also keeping people out of jail, all of those things that come with being arrested, being incarcerated, and all of the trauma as well as vocational and housing impact. Um, we also expanded our in intensive outpatient and partial hospitalization. This is a silly thing, but I love it a little bit about Colorado. Uh, partial hospitalization was really key for people who had for parents who could get day coverage for their kids, but not two weeks of coverage um to go into residential as an alternative to residential. But the other thing, we have more dogs than children in Colorado and people were not getting treatment because they didn’t want to leave their pets and they couldn’t afford to board them. So the partial hospitalization and inpatient treatment actually helped people who had other social determinance barriers that kept them out of inpatient residential even though they qualified. So those were some of the ways that we kind of uh expanded benefits, incentivized and changed around other benefits and then um expanded those inhome sports. I appreciate your very broad interpretation of the prevention question, Kristen, because all of those are preventative services in one way or another along the continuum. So, thank you for that. Um, Lee Robinson, I’d love um to for you to share a little bit about how you’ve been thinking about the prevention component. You’ve talked about this as a population health initiative and what does that mean at Mass Health. Yeah. Um, it’s hard to talk uh Kristen’s uh report. That was that was all really wonderful to hear. Um I think that the the first thing that I would just call out is is um that the CBHC’s themselves in this whole movement towards access and population health goals uh in a in a way is preventative in that it is giving a lot of people access to behavioral health care that they have potentially never you know pursued in the past um for whatever reason uh whether it’s stigma or you know I think a lot of times it’s just um logistics as far as making it to a specific clinic at a specific time and and so on and so forth. Um and so in fact at RC CBHC’s last year uh we looked and over 30% of the members who had a new um visit had no prior behavioral health care in in the previous six months. And so these are people who are potentially accessing behavioral health for the first time in a very very long time. Um and I think it’s because of you know the 247 access and and uh you know in every part of the state. Um, outside of the the the kind of specialty behavioral health space though, I think when when we think about prevention in behavioral health, we’re really talking about primary care. Um, and so I think that um, you know, leading up to 2023 um, when when our roadmap for behavioral health reform um, kicked off, there was a real effort of trying to expand access within primary care for um, preventative visits. And I think one of the things that was really called out um and I think it was particularly called out for youth is that you know in a lot of spaces you couldn’t actually get behavioral health care unless you had a diagnosis. And the diagnosis in and of itself was pretty stigmatizing and in in some ways a reason not to seek behavioral health because then it’s kind of in perpetuity in your in your records. And so in the middle of COVID, uh, our state stood up a really focused, uh, policy, uh, that grants all youth the ability to get up to six preventative behavioral healthcare visits within their primary care office. Um, and so there is zero need for a diagnosis. You can just use a Zcode, um, you know, uh, as a preventative visit, you know, to to to get the access to that care. And this is one of those services that uh is probably one of the most beloved policies that was was stood up amidst a lot of different policies over the years. Um and I think that it’s it’s it’s slowly gaining in in utilization because I think it’s a just a completely different way of thinking about behavioral health. Um but it’s I think it’s going to be opening a lot more doors in the years to come. Um, another uh another initiative in the behavioral health space is something that was actually driven a lot by our legislature um in kind of a one of the the framework behavioral health legislations that were passed in the recent years was the requirement for all payers to to pay for an annual behavioral health wellness visit. Um, and so in parallel with annual physical health wellness visits, now every single primary care office, whether it’s provided by a PCP or uh an embedded behavioral health clinician, um, everyone is eligible to receive a a comprehensive behavioral health uh, wellness visit. Again, no need for a behavioral health diagnosis. Um, and also this is this is an actual evaluation. This is not just a PHQ9 and and kind of being sent on your way. Um, and so this is this has been operationalized in a pretty robust way. Um, and we are still working out the kinks because it turns out that when you uh introduce behavioral health policy in the primary care space, you tend to break a lot of things uh as far as the payment logistics. And so we’re still working out those details. Um, but this is another uh initiative that people are really really excited about. And then I think I’d be remiss just to to mention one last thing is that uh our behavioral health roadmap uh fortunately coincided with the launch of our current 11:15 waiver. And uh one of the the biggest um kind of uh exciting changes in that 11:15 waiver was we fundamentally shifted how we pay for primary care in that we now pay for primary care uh as a subcapitation. And so um each of the the clinics are paid up per member per month. that’s risk adjusted um to provide primary care and that PMPM is tiered and each tier is based on the level of integration of behavioral health and and specialty medicine. And so basically paying uh incentivizing integration of behavioral health as a fundamental framework for paying for behavioral health um which again is uh it’s early on early days but I think is is is um very wellreceived. Um that’s that’s amazing. There’s so much to what each of you are offering here. Um and the good news is we are doing a a series of these types of panels focused on behavioral health for the next few months. And so um you’re giving us great fodder for deeper dives in some of these areas um in the months ahead. So thank you for all of that. And I know folks in the audience are hungry for more and more detail on each of these things and um we will do our best to follow up with that detail. Um I’m going to field one more question before we turn to the audience submitted questions. Um and Lee Gman, I’m going to um circle back to you on this um topic of data. Um it’s come up a bunch in the conversation um already. Um you know, how can you tell us a little bit more about how you’re approaching um using the data that you now have as you told us? you know, now that we’re paying for um care through Medicaid, um you have new data, you have um more insight into who’s coming, what you’re seeing, what what the needs are. Um and you also have more data to work with in terms of measuring progress um and and um holding holding stakeholders accountable. So, can you tell us a little bit um about how um how you’re thinking about data and measurement in this context? Yeah, happy to, Allison. Um, and I’ll I’ll answer this from a couple perspectives. So, one in terms of our, you know, more open access community mental health centers. Um, again, still in the early stages in terms of what that data looks like. Um, aside from the priority populations that I mentioned, um, we’re at about 750 individuals, just to give that some context. Um and right now frankly we’re seeing about a 50% success rate in terms of some of those providers being able to um you know meet those marks in terms of the incentive payments. So obviously excited about that component. Um in addition to uh to that piece again I mentioned one of the the components is everyone at that point of service who goes into community mental health center for services is getting assessed for Medicaid eligibility. So obviously that’s having a significant impact in terms of just enrollment. Um we actually are even just establishing this is down into the weeds but just a separate benefit code. So we can just even get more detail that aside from the uh from those who are being determined eligible for Medicaid um we’re looking at between 8 and 10,000 who are eligible for just that behavioral health package which I know for some of you for much larger states that’s probably very small but again considering the overall um Medicaid population is about 70,000 in Wyoming again non-expansion state that’s a pretty significant number for us pretty significant amount of folks who are be able to get that service. Also, just pivoting to another area that I haven’t talked quite as much about. Um, Wyoming in in July of 2023 was a state that expanded access to postpartum benefits for pregnant women in Medicaid uh from 60 days to 12 months of postpartum benefits. And that’s been another really significant focus for us in terms of uh that that postpartum period and providing behavioral health supports. So, very excited for that. That’s an area where we’ve been very closely tracking what that data looks like. Um, and for example, you know, we’ve talked a lot about just how especially in rural areas, we can try to enhance the impact of the program, where folks can get services. Uh, so as a fee for service Medicaid program, uh, what we have now in terms of just access to that service is women can get that uh, depression screening uh, from a pediatrician or from or from their OB, wherever they’re getting that point of service. If we’re paying for multiple screenings, we’re fine with that. That is not an area where we’re concerned about paying for too many of those depression related screenings um because we think it’s very important. So, some of the outcomes that we’ve seen again in focusing on sort of this space in this particular population uh before we expanded that benefit to 12 months postpartum, we would see about 22% of women access a behavioral health service. And in and from again this is just from two years of data but what we’re seeing now is closer to 50% right around 48% of women accessing that uh behavioral health service in that first 12 months. So what does that lead? Right? Because if you’re not careful with the data, you can say, “Oh, wow. Well, our, you know, depression diagnoses have really increased in this amount of time. Maybe ER utilization has really increased.” And yes, that is all true, but the reason for that is because those services are happening and we are able to identify them where it’s much harder to in that 60-day postpartum period. So, for example, just as a a couple of numbers, um those women with depression, you know, went from about 2 to 9% from when we expanded that uh that eligibility period. Again, we don’t think that’s just because um that has been uh more prevalent or or anything like that. It’s simply due to the fact that those women are getting coverage for longer and they’re able to seek those services and hopefully get the help uh that they need. So those are some of the ways that we’re again from a couple different perspectives, but where we’re really trying to keep tabs on some of those key initiatives. One for our highest acuity folks with serious mental illness. Um and two for that uh that maternal health population is really where we’re focused uh in Wyoming right now. Thank you so much, Lee. Um well, I am going to use the time we have left to uh field as many of the questions that have come in. Thank you so much to our audience for all of the thoughtful questions that have been submitted thus far. Um, and so I’ll try and do some kind of rapid fire here. Um, Kristen, a question I’m going to direct to you first. There’s some questions related to um services for children particularly um and how you think about um access to behavioral health care um under EPSDT for example um uh and what sort of unique considerations you’re thinking about in terms of ensuring access to services for youth as you think about kind of this broader suite of um of reforms in Colorado. Yeah, absolutely. The EPSDT has been a really big issue for us. That’s the ear I’m going to look at it and say it. Early prevention, screening, diagnosis, and treatment. Um, for those of you who are aware of this program, really, it says that for 21 kids 21 and under, it doesn’t matter if the service is on your Medicaid benefit or not. If it’s medically necessary, then the kids can get it. Um, so for behavioral health, what we found is this was being really used a lot in residential spaces and it was really being used a lot to address placement challenges for kids and child welfare, but it wasn’t being used to keep kids well and to keep kids at home and keep families together, right? So that’s why we really have focused on that system of care model um, which is an evidence-based program. We actually traveled to New Jersey and Ohio and went to go see theirs. We got some national experts to help us out. Um, and what we did was kind of for the lower need folks. We did implement a no diagnosis program. So, this is we based our legislation on the California legislation which basically says use a Zcode or use a an um I think it’s an R code is a delayed uh um a delayed diagnosis code. The reason people weren’t getting diagnosed is one, you don’t know always what’s going on with a kid. Um, but two, there were a lot of parents and folks and physicians who said, “I don’t want to label this kid for the rest of their life, so I would prefer not to put it in there.” Um, so this, I think, helped ease access. We also saw our behavioral health administration non-Medaid dollars. Usually I’m like, “Hey, if you can get the federal dollars, don’t leave them on the table.” But sometimes you have to run programs that are pay agnostic that allow they ran an IMAT program which allowed for up to six visits tellaalth for kids. Um and they advertised it in schools. It was wildly successful and we had folks it was mostly individual therapists and after uh three to six sessions they are transferring the kid to something more long-term and getting the Medicaid reimbursement. But we said, listen, it with COVID and with the rates of youth suicide in Colorado, which are also just devastating, um we found this to be a really important program. So sometimes Medicaid isn’t, believe it or not, sometimes Medicaid isn’t the answer to your funding problem. Um so I think that that was really important and having our support was also important there for us not demanding, hey, everyone has to be enrolled and we have to use Medicaid dollars. Sometimes it’s just we’re doing the right thing and we’re supporting them as long as there’s that pathway that gets them into services. Um I think that that’s that’s plenty for now. I can put on our um intensive outpatient link uh that shows our system of care program which has just been started July 1st. Congratulations. Thank you. That would be great. Um Lee Robinson, I’m going to turn to you for a question um related to managed care. um you um you spoke bef you spoke earlier about how you’ve been actively leveraging your managed care partners to support I think working at the elbow um if I didn’t butcher the the metaphor um as you’re you know bringing up this system and recognizing um the intensive um handholding and ongoing support that’s necessary to really transform a system and and change behavior. Um, we’ve also talked about expanded access and um, you know, increasing access to providers across the network. And we’ve gotten some questions about um, how do you, you know, how do you how do you encourage and work with managed care to really increase provider networks and expand provider networks and support contracting between providers who may not have participated in Medicaid before or have um, partnered with managed care organizations before? Can you do you have any words of wisdom um based on your experience in Massachusetts for you know how to um really leverage your managed care system and um facilitate those relationships? You know, I was thinking of a reality show when you were talking about earlier, you know, speed dating and, you know, locking the doors and so forth. Um what insights would you share with our audience about ways to really um bolster and remove barriers from those um those relationships? Yeah. No, it’s a great question and I I’m not sure that we’ve I would say that we’ve, you know, cracked the case and and and solved it all. Um but I do think that um I think that one thing that I would come back to is the piece around data um in the sense that you know can’t say enough uh about how important data is and uh I really mean that in all the various data formats you can think of. um in the sense of you know we rely heavily on claimsbased data um but we also have uh a lot of actually non-claimbased data that we’ve un unfortunately for the providers we’re requiring them to be reporting in real time because it’s really the only way to get data you know that’s even remotely accurate within six to nine months of when the the service actually happened and particularly in the first year and and uh we needed more real-time access to data um in a way that claims was just not able to to provide. And and I think at this point in in our process, we’re trying to kind of taper down the self-reported data, but we still have some pretty cru crucial KPIs in the self-reported data that um really provide a much more nuanced picture of things. And how I’m connecting that dot of data to the managed care is that um we are able to to to break down that data um at the plan level um and also at the provider level. And I think that um other than money, I think the only other better incentive in in our world is shame um and uh and guilt. And so I think that we have pretty clear pictures of where there are partnerships that are working and how they are resulting in better care, better access um for members and for the plans um and where there are clear opportunities in which plans and providers have not built those relationships and it’s resulting in um just honestly more costly care. Um and so I think that uh we have been taking those data narratives and talking directly to the plans and the providers you know in the in the relative regions and uh particularly if you can compare them to their competitors and compare them to um you know other other entities in the state that that are clearly doing it better than them that has been a very effective point of leverage. Um, and so I I don’t know that we we’re not printing any mission accomplished banners yet, but I do think that um, you know, the plans are so focused on kind of one-year return on investment, doing things the way we have to have to do them. And and like the notion of network adequacy is honestly not that robust. And I and I think that, you know, we’re trying to think about how to improve that. Um, and so, uh, the the data narratives and comparing them to their competitors, I think, has been the most effective way to to get them on board. That’s great advice there. And, um, would love to dig into that deeper as, as one more example of, um, places where I think, um, members of our audience would be super interested to replicate some of the best practices because by the time you wait for the claims to show up, you’ve sort of missed the early warnings um, and the opportunities to to intervene. So, that’s, um, that’s fantastic. Okay, I’m going to ask one last question of all of you. This question has come up from our audience um in a number of of places and it’s you know it’s the um you know billion dollar trillion dollar question on the table um related to the environment we’re in um the uh cuts coming down the road to funding um and um just reflecting on what does that mean for these for these efforts um that you’re so invested in that your states have um so much stakeholder support up and down the chain um from community members up through the governor’s office. How are you thinking about maintaining the progress that you have um that you have made um through all of this effort um in recent years in light of the new financial realities that your states are facing? Um and so Lee Gman, I’ll turn to you first. Thanks Allison for the fun question. Uh take a bite at that one first. So a little context, Wyoming, you know, I already mentioned we’re not an expansion state. So accordingly, you know, take my comments in that vein in terms of the impact that we expect um significantly uh less than I think what my I suspect my other colleagues might u might be feeling. So accordingly, you know, what we’ve modeled out is is uh pretty minimal in terms of coverage loss or certainly cuts. Um perhaps to the contrary, the rural health transformation uh program that got put into the bill, um $50 billion, half of that is evenly dispersed across states. The other half, you know, there’s a TBD formula there, but that’s going to be a really significant investment for Wyoming. So, I would actually in looking at perhaps the glass half full perspective here and avoiding the cut part of that of that, we’re actually expecting to for it to be a net gain for Wyoming to for that one-time uh opportunity, of course, long-term different conversation um to where that’s a really significant amount of money. We’re talking, you know, minimum $500 million over the course of five years. Um for a state like Wyoming, that’s huge. So when we talk about how we can leverage that money, um it’s going to be a significant conversation with our legislature, governor’s office, but how we maintain and frankly expand some of the access to behavioral health services, I think is going to be uh front and center as we’re as we’re looking at that. So, I see the opportunities for expansion in terms of our behavioral health options uh in rural Wyoming, which is all but two of our 23 counties to be um a really significant opportunity where we’re able to actually juice this more than we have today. Great, Lee. We’re happy for Wyoming um and appreciate you um injecting some some uh some hopefulness into um an otherwise bleak question and um the ideas shared um from uh Colorado and Massachusetts here among other ideas are great fodder for how to use that um influx of resources um while they’re available. For sure. Um Chris, I’m going to turn to you and then Lee, you for the final word and just keeping an eye on the clock, you know, um you know, your best thoughts in a minute or less. Yeah. Um, I think that this is just going to be incredibly difficult. Like I said, uh, for a state that’s made a lot of strides and a lot of progress. Our goal is to not backslide, right? And so, we’ve got to again take a look at our cost trends and see where we can level them out um to protect them because if they keep going up, then guess who’s got a bullseye, right? Uh, behavioral health is one of the leading cost drivers right now for Colorado Medicaid. Um, and two years ago when I told people we doubled our investment, I got applause. Now I’m getting booze. Right? So I think that the challenge is we’ve got to take the work that’s happened. We’ve got to make sure we’re ending programs that didn’t work, right? We I I had a I had an answer to a question we didn’t get to, but like sometimes you need to stop a program and there will be abrasion. It will be difficult. Um, providers are upset. I’m upset. Right. Everybody’s Nobody’s going to get out of this untouched, right? Um so what we’ve really tried to do is say what pro what programs are working? What programs were hopeful may? And let’s pull those back. Let’s see where we can um stop a program before it starts if possible. Those are some of the strategies that we’ve taken on. Um I think one of the hardest parts about this is the administrative requirements that are going to require massive tech builds. Uh we are going to be taking money directly from pro providers and giving it to tech firms. That is not my idea of uh thoughtful health care cost spending strategies. So, we’re really trying to make sure that we have our um that we’re going to be using our 9010 funding for those uh for those technology changes as much as possible. Uh we have some reinvestment funds from our 1115 that we’ve protected previously in statute. Be happy to share that statutory information that was a tip from other Medicaid uh folks around how to keep your 1115 clean and in compliance. Um and those are our our key elements. But I think also just somebody said at the beginning, make your expectations clear and restate them often. This is going to be difficult for all of us. Um, please help us make it as precise and thoughtful and data driven as possible. Um, and avoid everybody just saying please not me because that’s going to lead us to a bunch of people saying, you know, the loudest person with the most lobbying funds is going to end up winning that fight. Be strategic. Be thoughtful. be a collaborative partner and we can get through this together. Thank you, Kristen. Um, Lee, we’ll give you a um a quick moment for a for a last word here if you would if you would like it. Yeah, I I I don’t know that I can top what Kristen said. I I agree with every single word that she said and so um yeah, nothing more to add. Yeah. Well, um we’ve reached our time. Um I want to thank this panel so much. um this could have been a 10-hour conversation with all of the um just rich insights and experience and innovation that you all have to share across um a continuum of populations, geographies, services that I think any one of our audience members could relate to in some way. So, thank you for being so generous with your time and for your leadership in these efforts um in your states. We look forward to continuing to track your successes and to celebrate um them and to disseminate the lessons learned to um all of those around the country who are similarly invested in and carry caring about these issues. Um up on the side are um uh some upcoming events and topics we’ll be focusing on. So um keep uh keep a breast of what we’re putting out there and hopefully you can join us for additional installments in this in this series. Um, we’ll have an evaluation pop up if you have time to share any thoughts with us. We appreciate that. We have a state initiative out on uh right now that we are um hoping for the opportunity to support a number of states in these types of robust comprehensive reform efforts in the months ahead. So, uh, keep an eye out for that
Millions of people depend on Medicaid for their health care — and it is the nation’s largest payer of behavioral health services. Yet, far too many Medicaid members face serious obstacles accessing the mental health and substance use care they need. This challenge is especially urgent in rural and under-resourced communities, where provider shortages and limited resources often leave individuals without timely, appropriate care. For many people, emergency departments and the criminal justice system become points of entry for behavioral health care — rather than last resorts.
Medicaid holds some of the most important levers available for strengthening access to essential behavioral health services. In this virtual panel hosted by the Center for Health Care Strategies (CHCS), state leaders from Colorado, Massachusetts, and Wyoming shared how they are tackling behavioral health challenges and using Medicaid policy to improve access to high-quality care in their states. Panelists explored how states can expand access, improve coordination, and modernize behavioral health care through cross-sector partnerships, workforce development, cross-agency data sharing, and integrated approaches to care.