HEALTHY TRANSITIONS TO ADULTHOOD POLICY …

HEALTHY TRANSITIONS TO ADULTHOOD

POLICY IMPLICATIONSPOLICY IMPLICATIONS

N K l ffNancy KoroloffGary MacbethMartin RaffertyJanet WalkerGwen White November 18, 2010

Policy and Young Adults of Transition AgePolicy and Young Adults of Transition Age

• Issues well documented

• Opportunity for change

• Challenges to address

© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY

An Examination ofAn Examination ofThe Youth Mental Health

Bill f Ri htBill of Rights


Young Adults’ Relationship to PolicyYoung Adults Relationship to Policy

• Primary interest is found in specific needs (and not y p (entire programs or models)

• Adult partnership is a necessityAdult partnership is a necessity

• History of similar-minded policy changes useful

• Involvement by focus groups as an advantage


Young Adults’ Relationship to PolicyYoung Adults Relationship to Policyand

Youth Mental Health Bill of Rights

AUDIENCE POLLAUDIENCE POLL



• Signed and created by 30 mental health service experienced youth gathered in Portland OR fromexperienced youth gathered in Portland, OR from the following states: California, Hawaii, Idaho, Illinois, Kentucky, Maine, Massachusetts, Missouri, Michigan, New York, North Carolina, Oregon, Texas, and Washington.


History of the Youth Mental HealthHistory of the Youth Mental HealthBill of Rights

• Summer 2009 Creation• Summer 2009 – Creation

• Fall 2009 – May 2009 Survey and Edit

• May 2010 - Bill signed as part of a Proclamation by the Governor of Oregon

• Summer 2010 - Document adopted and plans for distribution rolled outdistribution rolled out


Youth Mental Health Bill of RightsYouth Mental Health Bill of Rights

1.) Youth have the right to be leaders of their psychiatric1.) Youth have the right to be leaders of their psychiatrictreatment plans.

• Youth should be informed of the possible side effects ofYouth should be informed of the possible side effects of medications, how long recommended medications take to go into effect, and the possible long-term effects of recommended medication. Service providers should work

i h h l ibl l i iwith youth to explore possible alternatives to using psychiatric medication before medication is given. Communication between youth and all medical providers should be collaborative clear and with limited use ofshould be collaborative, clear, and with limited use of medical terminology.



2.) Youth have the right to evaluate their mental health services.

• Mental health counselors, social workers, psychologists, and th i id h ld id t iti fother service providers should provide opportunities for

youth to evaluate the satisfaction of their services throughout the duration of care in a respectful and non-threatening manner This includes evaluation of the relationship with themanner. This includes evaluation of the relationship with the provider, counseling plans, and implemented treatment models.



3.) Youth have the right to service transitions that arei i iblas non invasive as possible.

• When youth are transitioning into new services, mental health h ld t i t k th t itiprograms should strive to make the transition as

accommodating as possible for the youth. Youth should be consulted on the ways they would like to end their relationship

ith th t id d h th th ld lik thwith the current provider and whether they would like the current provider to share their file with their new provider. Providers should share if there will be any changes in the costs

f i d/ iof services and/or insurance coverage.



4.) Youth have the right to trained, sensitive treatment providers.

• Youth should have access to mental health professionals that f ili ith th i d d h ll f thare familiar with the unique needs and challenges of youth

with mental health needs. All mental health professionals should have specialized training that fosters positive youth development and support Youth mental health servicedevelopment and support. Youth mental health service consumers should be included in the creation and implementation of these trainings.








QUESTIONS AND DISCUSSIONQUESTIONS AND DISCUSSION



POLICY TRANSFORMATION – LITERATURE• Continuity of care ages 16 to 25 or 30• Coordinate care across systems• Support appropriate family role to ages 25 – 30• Developmentally appropriate and appealing servicesp y pp p pp g• Density of good services• Expertise in age group and populationExpertise in age group and population

Adapted from: Hoffman, C., Heflinger, CA., Athay, M., & Davis, M. (2009). Policy, Funding and Sustainability: Issues and Recommendations for Promoting Effective Transition Systems. In H.B. Clark & D.K. Unruh Transition of Youth & Young Adults with Emotional or Behavioral Difficulties (pp263 290) Baltimore: Paul H Brookes Publishing Co


Difficulties (pp263 – 290). Baltimore: Paul H. Brookes Publishing Co.

Policy and Young Adults of Transition Agey g g

POLICY TRANSFORMATION – FINANCINGEli ibili d d i d f i i• Eligibility standards tied to functioning

• Medicaid Eligibility– Combine low income and disability categoriesCombine low income and disability categories– SSI - “child” list of diagnosis up to age 25 / 30

• Remove Disincentives for work / employment

Include disability OR condition– Include disability OR condition– Functional Definition – readiness to assume adult roles– Include “at risk” categories

• Service array– Cover needed transition support services– Linkages to families


Linkages to families


• Young Adults of Transition Age:– Not being examined on the federal level

• Health care reform• Medicaid expansion• Medicaid expansion• Eligibility

• State Level Decisions– Be at the table– Inform– Advocate


Citations and ResourcesCitations and Resources

• Davis, M., & Koroloff, N. (2006). The great divide: How public mental health policy fails young adults. In W.H. Fisher (Ed.), Community based mental health services for children y g ( ) y fand adolescents (pp. 53-74) (Vol. 14). Oxford, UK: ElsevierSciences.

• Hoffman, C., Heflinger, CA., Athay, M., & Davis, M. (2009). Policy, Funding and Sustainability: Issues and Recommendations for Promoting Effective Transition Systems. I H B Cl k & D K U h T iti f Y th & Y Ad lt ith E ti lIn H.B. Clark & D.K. Unruh Transition of Youth & Young Adults with Emotional or Behavioral Difficulties (pp263 – 290). Baltimore: Paul H. Brookes Publishing Co.

• Policy recommendations to promote and sustain effective community transition systems. (Clark HB Deschênes N & Unruh DK 2010) Tampa FL: National Network on Youth(Clark, HB, Deschênes, N., & Unruh, DK,, 2010).Tampa, FL: National Network on Youth Transition for Behavioral Health.

• Summary of Center for Mental Health Services Youth Transition Policy Meeting: National Experts Panel, Held June 8-9, 2005, Rockville, MD (M. Davis, Center for Mental Health p , , , , ( ,Services Research, Department of Psychiatry, University of Massachusetts Medical School & C. Koyanagi, Bazelon Center for Mental Health Law for the Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, Final Report September 2005)






QUESTIONS AND DISCUSSION


Overview

Selected Provisions of the Affordable Care Act

National Technical Assistance CenterAssistance Centerfor Children’s Mental Health


Our Take Home MessageOur Take Home Message• Opportunities - The Act provides many options for states to

improve behavioral health (MH and SA) services for young improve behavioral health (MH and SA) services for young adults.

• Advocacy - To realize these opportunities, you have to grab a t t th t t t bl h d i i thseat at the state table where decisions on these

options will be made.

• Get the positive message out!


We are Going to Talk AboutWe are Going to Talk AboutFour Primary Sections of the Act

• Health Insurance Provisions of the Act

• Health Exchanges

• Medicaid & CHIPMedicaid & CHIP

• New Programs and Workforce Provisions


Provisions of the Affordable Care ActProvisions of the Affordable Care Act• Pre-Existing Medical Conditions: Sec. 2704: Prohibits

discrimination (children – ended September 2010; adults – will end discrimination (children ended September 2010; adults will end January 1, 2014).

• Co-pays for Preventive Services: Ended September 2010).p y p )


Provisions in the Affordable Care ActProvisions in the Affordable Care ActHealth Insurance for Young Adults:• Sec 2714: Young Adults can be covered on their parents plan to • Sec. 2714: Young Adults can be covered on their parents plan to

the age of 26 (September 2010).

• Sec 2004: Young adults previously in foster care qualify for • Sec. 2004: Young adults previously in foster care qualify for Medicaid and EPSDT to age 25 (2014).

Opportunity: Work with your state to ensure that young adults from Opportunity: Work with your state to ensure that young adults from foster care receive the full complement of medically necessary child and adult services, regardless of whether they are in the State Plan.


Source: Bazelon Center

Health Insurance ExchangesHealth Insurance Exchanges

• Essential Benefits Package (for Health Plans in Exchanges): Sec 1302: Requires all health plans in Exchanges to offer Sec. 1302: Requires all health plans in Exchanges to offer essential benefits, including rehabilitative and habilitative services, and allows for additional mental health and addiction servicesaddiction services.

• Premiums: Sec. 1401(36B): Establishes premium assistance credits for individuals and families that have incomes at or less credits for individuals and families that have incomes at or less than 400% of the federal poverty level.


Health Insurance Exchanges

Th f d l S t f HHS h d d t t t t t • The federal Secretary of HHS has awarded grants to states to establish American Health Benefit Exchanges by Jan. 1, 2014. Funds will help pay for the design and implementation of E h Exchanges.

• Opportunity: Become a member of one of the design or y gimplementation teams to help shape the benefit packages to ensure a broad range of behavioral health services are offered.


Health Insurance Exchangesg

• Outreach and Enrollment Efforts: Sec. 2201: Allows individuals to apply for and enroll in Medicaid, CHIP, or Exchanges through Web sites administered by states and using a simple two-page form (Express Lane Eligibility).

• Navigators: Requires states to offer assistance to individuals to help them get into the right plan. p g g p


Health Insurance Exchangesg

• Opportunity: Ensure that the application uses language that can easily be understood can easily be filled out by young adults and individuals be understood can easily be filled out by young adults and individuals with limited education or language skills.

Opport nit Become part of the marketing team that ill help as man • Opportunity: Become part of the marketing team that will help as many individuals as possible enroll in the various health plans.


Medicaid and CHIP

Why Is This Expansion Important For State Behavioral Health Agencies?Agencies?

• The expansion of Medicaid to 133% of poverty and increased CHIP coverage to about 6.5 million additional children is

ti t d t i ll t i th b 33% b estimated to increase enrollment in the programs by 33% by 2019.

Thi i ill t f th l t d ti i • This expansion will account for the largest reduction in uninsured populations, followed by the Health Exchanges.

• Large numbers of uninsured individuals estimated at around • Large numbers of uninsured individuals, estimated at around 20%, have mental health or substance use problems (Kaiser Family Foundation, 2009).


Federal Medical Assistance Percentage g(FMAP) for New Medicaid Enrollees

2014 15 d 16 100%• 2014,15, and 16 100%• 2017 95% • 2018 94%• 2018 94%• 2019 93%• 2020 and beyond 90%2020 and beyond 90%


Medicaid

• Medicaid Medical Home Pilot: Sec 2703: Provides states the option of enrolling Medicaid beneficiaries into a health home option of enrolling Medicaid beneficiaries into a health home through a State Plan option. The Medical Homes would be designed to better serve persons with chronic illnesses, serious

t l ill d/ ddi ti di d M di l H b mental illness, and/or addiction disorders. Medical Homes can be established in community behavioral health organizations (begins 2011).


Medicaid

• Opportunity: Encourage your state to establish Medical Homes in community mental health centers as a means of offering high community mental health centers as a means of offering high quality physical care, behavioral health treatment, and coordinated care for individuals with serious levels of mental illness, funded by increased FMAP – 90% for two yearsincreased FMAP – 90% for two years.


Medicaid

• Increasing Access to Home- and Community-Based Services: Sec. 2401: Creates a new Community First Choice Option, allowing Sec. 2401: Creates a new Community First Choice Option, allowing States to offer community based attendant services and supports for individuals with incomes below 150% of poverty (begins October 2011). October 2011).


Source: Bazelon Center: Medicaid Reforms in the Patient Protection and Affordable Care Act

Medicaid• 1915(i) State Plan Amendment (Sec 2402): States can amend

their State Plans to offer HCBS as State Plan option benefits.• Income eligibility is up to 150% of federal poverty level or 300% of

the maximum SSI payment.States can do one plan amendment with several target populations • States can do one plan amendment with several target populations.

• Cannot waive state-wideness, but can target a specific population– Children with SEDChildren with SED– Young adults of transition age with SED– Two or more hospitalizations p– Involved with child welfare


Source: Bazelon Center: Medicaid Reforms in the Patient Protection and Affordable Care Act

Medicaid and CHIPed ca d a d C

Payments to primary care physicians:M di id t t t i h i i f i • Medicaid payment rates to primary care physicians for primary care services be no less than 100% of Medicare payment rates in 2013 and 2014.

• Provides a 100% federal match for meeting this requirement.

Opportunity: To work with primary carepp y p ypractitioners to do behavioral healthscreens and referrals.


Money Follows the Persony

• $2.25 billion in grants to extend the Money Follows the Person Rebalancing Demonstration to more statesRebalancing Demonstration to more states.

• Under the MFP demonstration, states will receive an enhanced Federal Medical Assistance Percentage (FMAP) for a one-year period for each Medical Assistance Percentage (FMAP) for a one-year period for each individual they transition from an institution to a qualified home and community-based program.

• The extension of the MFP Demonstration program goes through 2016.


New Program Opportunities

• Co-Location of Primary and Specialty Care in Community-Based Behavioral Health Settings: Sec 5604: Authorizes $50 Based Behavioral Health Settings: Sec. 5604: Authorizes $50 million in grants for coordinated and integrated services for adults through the co-location of primary and specialty care in community-b d t l d b h i l h lth ttibased mental and behavioral health settings.

• Opportunity: To develop a public health approach to services for d lt f t iti young adults of transition age.


Workforce Opportunitiespp

• Training for Behavioral Health Professionals: Sec. 5306-756: Allows the HHS secretary to award grants to schools for the Allows the HHS secretary to award grants to schools for the development, expansion, or improvement of training programs in social work, graduate psychology programs, professional training in child and adolescent mental health, and pre-service or in-service child and adolescent mental health, and pre service or in service training to paraprofessionals in child and adolescent mental health(funding from 2010 to 2013).


Workforce OpportunitiesWo o ce Oppo tu t es

• Loan Repayment for Pediatric Behavioral Health Specialists in Underserved Areas: Sec 5203: Establishes and authorizes funds for a Underserved Areas: Sec. 5203: Establishes and authorizes funds for a Pediatric Specialty Loan Repayment Program for individuals who are employed in health professional shortage or medically underserved areas for at least two years and provide pediatric medical subspecialty; areas for at least two years and provide pediatric medical subspecialty; pediatric surgical specialty; or child and adolescent mental and behavioral health services, which include substance abuse prevention and treatment servicesand treatment services.



• Educating Primary Care Providers About Behavioral Health:• Educating Primary Care Providers About Behavioral Health:Sec. 5405: Establishes and authorizes funds for a Primary Care Extension Program to educate primary care providers about preventive medicine; chronic disease management; mental and preventive medicine; chronic disease management; mental and behavioral health services, which include substance abuse prevention and treatment services; and evidence-based and evidence informed therapies and techniques evidence-informed therapies and techniques.



• Community Health Workforce Grants: Sec. 5313: Authorizes grants to eligible entities to promote positive health behaviors and grants to eligible entities to promote positive health behaviors and outcomes for populations in medically underserved communities through the use of community health workers.


Citations and ResourcesThis presentation utilized the following organization web-sites:

• Government Health Care Website www HealthCare Govwww.HealthCare.Gov

• National Council for Community Behavioral Healthcarewww.TheNationalCouncil.org

• The Kaiser Family Foundationwww.kff.org

• The Robert Wood Johnson FoundationThe Robert Wood Johnson Foundationwww.rwjf.org

• The Bazelon Center for Mental Health Lawwww bazelon orgwww.bazelon.org

• The federal Centers for Medicare and Medicaidwww.cms.gov


• The Washington Post www.washingtonpost.com




Questions ReflectionsQuestions, ReflectionsAnd

C ti i Th Di iContinuing The Discussion

pathwaysrtc


QuestionsQuestions

• How well might the new policies in the ACA address• How well might the new policies in the ACA address the “old” problems?– Continuity of care– Access to case management/intensive case management– Access to non-traditional services/supports such as supported

l temployment


QuestionsQuestions

• How will special provision for young people aging out of foster care work? – What are the benefits?

• What about other populations with “special medical needs” and does this include young adults with SMHCs?SMHCs?


Keeping the Discussion GoingKeeping the Discussion Going

• Youth Advocacy Training Webinar Series– Beginning Saturday December 4, 2010– FREE Four Part Series– http://www.ffcmh.org/youth-focus/leadership-development-for-youth/

• Strengthening Outcomes for Cross-Over Youth (ChildStrengthening Outcomes for Cross Over Youth (Child Welfare/Juvenile Justice) Transitioning into Adulthood– Next TA Center W0ebinar

December 16 2010– December 16, 2010– https://www4.georgetown.edu/uis/keybridge/keyform/form.cfm?FormID=33

31



• Video / Podcast: Rites of Passage: Young Adults and the g gAffordable Care Act of 2010. The Commonwealth Fund– http://www.allhealth.org/briefing_detail.asp?bi=186

• Websites that provide updates on implementation of ACA– Bazelon Center for MH Law: www.bazelon.org/– Kaiser Family Foundation: healthreform kff org/Kaiser Family Foundation: healthreform.kff.org/– Federal Government: www.healthcare.gov/– The National Association of State Medicaid Directors:

http://www nasmd org/Home/home news asphttp://www.nasmd.org/Home/home_news.asp– National Council for Community Behavioral Healthcare:

http://www.thenationalcouncil.org



• Pathways RTC Project – Transition Policy ConsortiumConsortium

1) Yearly focus on a policy issue thatM tt t th/ d lt d t / i• Matters to youth/young adults and parents/caregivers

• Could reasonably be modified to support young people in transition

2) Work with stakeholders to understand the current policy, synthesize available research, identify best t t istrategies• Through web based review and input, conference calls


Keeping the Discussion Going

3) Produce an action-oriented report or resource each yeareach year• What policies need to be changed? Or• How can we get results working within/around current

policy?

• This year will focus on Affordable Health Care Act d it i li ti f l i t itiand its implications for young people in transition

• Currently recruiting for first stakeholder group to convene in January 2011convene in January 2011

• Sign up: http://www.pathwaysrtc.pdx.edu/• or e-mail koroloff@pdx edu


• or e-mail [email protected]


• Data Matters- an Interactive Electronic Newsletter that highlights the importance of data, spreads the word about evaluation strategies and outcomes andword about evaluation strategies and outcomes, and keeps readers up to date on the latest in the field. http://www.gucchdgeorgetown.net/data/

• Evaluation – please complete the evaluation. We value your feedback and use it for quality improvement.


Contact UsGwendolyn White, M.S.W.Georgetown University National Technical Assistance Center for Children’s Mental HealthWashington, DC andGreat Lakes Behavioral Research InstitutePittsburgh, PA724-387-1258gwhite@greatlakesresearch [email protected]

Martin RaffertyYouth MOVE Oregon

lh OMarylhurst, OR [email protected]

Nancy Koroloff, Ph.D.Portland State University : RTC for Pathways to Positive FuturesPortland, OR503 725 4180


[email protected]

Contact UsContact UsGary Macbeth, M.S.W., M.Ed.Georgetown University National Technical Assistance Center for Children’s Mental HealthWashington, [email protected]

Janet Walker, Ph.D.Portland State University : RTC for Pathways to Positive FuturesPortland, [email protected]


Documents

HEALTHY TRANSITIONS TO ADULTHOOD POLICY …