Medicaid Behavioral Health
Care in New York
July 2015
Presentation Overview
• What are the Goals for the Medicaid Changes? • What is Medicaid Managed Care?
• Changes to Medicaid Behavioral Health (mental health and substance use) Care
• Health and Recovery Plans (HARPs)
• Home and Community Based Services (HCBS) • Qualifying for a HARP
What are the Goals for the
Medicaid Changes?
Better Health
Better Care
Greater Access
Lower Costs
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July 2015
Changes to Medicaid Behavioral Health Services
• Who will see these changes?
• People 21+ with Medicaid Managed Care ONLY • People 21+ receiving SSI ONLY
• Most people with Medicaid will have some changes in
the way they get mental health and substance use
Right now, these changes are not for
people who:
• Have both Medicaid and Medicare • Live in a nursing home
• Are in a Managed Long Term Care Plan • Are under age 21
• Have services from the Office for People with Developmental Disabilities (OPWDD)
Medicaid Managed Care Plan
• Medicaid Managed Care plan – a health insurance plan for people who get Medicaid benefits
• Medicaid Managed Care plans contract with a network of providers to deliver all covered benefits and services, to help people get and stay healthy and get the medical care they need
July 2015
Medicaid Managed Care Covered Services:
Mental Health
• Mental Health Inpatient Rehabilitation • Mental Health Clinic
• Partial Hospitalization
• Personalized Recovery Oriented Services (PROS) • Assertive Community Treatment (ACT)
• Continuing Day Treatment (CDT)
• Comprehensive Psychiatric Emergency Program (CPEP) • Intensive Psychiatric Rehabilitation Treatment (IPRT)
Medicaid Managed Care Covered Services
-Substance Use Disorders
• Inpatient Substance Use Disorder Treatment
• Opioid, Including Methadone Maintenance, Treatment • Outpatient Clinic
• Detox Services
Changes to Medicaid Behavioral
Health
How Is My Care Changing?
• Medicaid Managed Care Plans currently provide physical health and some behavioral health care services for people with Medicaid
• Now, plans will provide additional mental health and substance use benefits for people
• Medicaid Managed Care plans will send a letter to all people letting them know that their plan now provides expanded behavioral health benefits
July 2015
What Do These Changes Mean?
• Medicaid Managed Care plans will expand their efforts with behavioral health care to help people reach their health,
recovery, and life goals
• Medicaid Managed Care will offer new behavioral health services that people can get in their community
• Doctors and other service providers will work together to help Medicaid Managed Care people meet their chosen health,
July 2015
Health and Recovery Plans (HARPs)
• New type of Medicaid Managed Care plan
• Designed for people with serious mental health conditions and substance use disorders
• Cover all benefits provided by Medicaid Managed Care plans, including expanded behavioral health benefits
• Also provide additional specialty services to help people live, go to school, work and be part of the community
How are HARPs different than other
managed care plans?
• HARPs specialize in serving people with behavioral health conditions
• HARPs cover additional rehabilitative services called Home and Community Based Services (HCBS)
• Some people in HARPs will be eligible for HCBS
• A Care Manager will help people in HARPs and service providers work together
Home and Community Based Services (HCBS)
• Help people improve their quality of life, including getting andkeeping jobs, getting into school and graduating, managing stress, and living independently
• Designed to help people meet their recovery and life goals
• Only available to people in HARP and HIV Special Needs Plans • Only available for people who qualify
July 2015
Home and Community Based Services (HCBS)
Find Housing. Live Independently.
• Psychosocial Rehabilitation
• Community Psychiatric Support and Treatment
• Habilitation
• Non-Medical Transportation for needed community services
Return to School. Find a Job.
• Education Support Services • Pre-Vocational Services • Transitional Employment
• Intensive Supported Employment • Ongoing Supported Employment
Get Help from People who Have Been There.
• Peer Support Services
• Family Support and Training
Manage Stress. Prevent Crises.
• Short-Term Crisis Respite • Intensive Crisis Respite
• In order to get HCBS, people will need an assessment
• Assessment shows if people are eligible for HCBS and which HCBS they need
• People in HARPs will have a Health Home Care Manager who completes the assessment
• Care Managers also help people in HARPs make a Plan of Care
• A Plan of Care identifies life goals and the services people need and want to help reach their goals
• People’s ideas and what they want will be very important in making the Plan of Care
When do these changes happen?
Medicaid eligible people who live in New York City
• Medicaid Managed Care plans are scheduled to begin coverage of
expanded behavioral health services in October 2015, pending federal approval
• Home and Community Based Services will become available later to eligible people in HARPs and HIV SNPs
July 2015
When do these changes happen?
Medicaid eligible people who live outside of New York City
• Medicaid Managed Care plans are scheduled to begin
to cover the expanded behavioral health services in
July 2016, pending federal approval
July 2015
How do people know if they qualify for a HARP?
• HARP eligible people will get a letter telling them they are eligible and how to enroll. The letter will tell people:
• About their choices for joining a HARP • What to do next
• Where to get more information
Joining a HARP – Passive Enrollment
• Some people who are eligible for HARP enrollment do not have to do
anything to join - they will be automatically enrolled in the HARP that is run by the company that runs their current Medicaid Managed Care plan. These
people will get a notice to tell them:
• That they are eligible for HARP enrollment
• That they do not need to take action to join a HARP • How to choose a different HARP if they want to
• That they can choose not to be in a HARP and can stay in their current plan • That they must respond to the notice to opt out
July 2015
Joining a HARP – Active Enrollment
• Other people who are eligible for HARP enrollment will have to choose to enroll in a HARP – the company that runs their current Medicaid Managed Care plan does not offer a HARP
• These people will get a notice to tell them:
• That they are eligible to join a HARP • How to join a HARP
Joining a HARP for People in HIV
Special Needs Plan (SNP)
• HIV Special Needs Plans (SNPs) cover the expanded behavioral health services covered by a Medicaid Managed Care plan, plus the specialty services covered by HARPS
• HIV SNPs also provide additional care that is NOT covered by other plans
• HARP eligible people enrolled in an HIV SNP will also receive a notice to tell them:
• They are eligible for HARP enrollment
• That they can stay in their HIV SNP plan and get HCBS if they are eligible
• That they do not need to take action to be eligible for the extra benefits that HARPs provide
July 2015
Where Can People Get More Information?
• NYS Office of Mental Health (OMH) Office of ConsumerAffairs: 518-473-6579 • Office of Mental Health
• Office of Alcoholism and Substance Abuse Services (OASAS)
• Department of Health (DOH)
