While the health care system has been the target of many of the proposed bills filed during the legislation session, one important issue has practically gone unmentioned—access to adequate behavioral health services for children.
These gaps continue to make the behavioral health system one of the drivers of unmet health care needs and costs in Medicaid. For instance, the five percent of children and adults who receive treatment account for more than half of Medicaid spending on behavioral health treatment in the state. Also, data shows that over 20 percent of high school students in Arkansas report having more than five drinks in a row and taking prescription drugs without a doctor’s prescription. With children and adolescents making up about 70 percent of the population receiving behavioral health treatment in Medicaid, this remains a critical child health issue in Arkansas.
Though efforts to transform the system have slowed down recently, this is not a new issue. A lot of work has occurred since 2006, when a national expert conducted an assessment of the system and made recommendations to the state legislature. A few of the concerns highlighted in this assessment were: children’s outcomes were not being measured across the system or statewide, families were not included in the majority of treatment children received, inpatient and residential treatment utilization was very high, community based intensive treatment options were limited, and local communities lacked advocacy and support resources for families. A statewide listening tour and report also documented families’ experiences, and Act 1593 of 2007 was passed to create the Arkansas Children’s Behavioral Health Care Commission to advise the Department of Human Services (DHS) on making changes to the system. A number of helpful initiatives, primarily funded through state dollars and grants, have been implemented over the years, but gaps in the system remain.
Recently, DHS has focused on permanently transforming the behavioral health system by making changes to the Medicaid payment model (i.e. episodes of care) and addressing several of the ongoing issues identified in early assessments. After making major investments in a series of stakeholder meetings and support from a national consulting firm, a plan was released in October 2014 for formal feedback and legislative approval. However, efforts to move forward with this comprehensive and much needed transformation effort have gone silent lately, with the exception of legislation to identify a new standardized outcomes tool.
We know what works to improve quality of care in Arkansas because of several successful pilots and grant funded projects on intensive care coordination and home and community based services and best practice research (progress is regularly reported in the annual report from the Commission). Based on this research and stakeholder input, the plan proposed several major changes including:
- Providing care coordination and more integrated treatment to control costs and improve quality
- Identifying a permanent mechanism for funding several evidence-based home and community based services through Medicaid (including new federal funding)
- Improving access to substance use disorder treatment mainly by expanding populations served to all Medicaid beneficiaries and aligning provider reimbursement rates for substance use disorder treatment and mental health services
As the legislature considers the future of the health care system in state, transforming the behavioral health system for children remains one of the highest priorities. The next major step is to make these critical changes to ensure children in Arkansas have adequate access to mental health and substance use disorder treatment within every community. The newly created Health Reform Legislative Task Force must make it a priority to address the gaps in behavioral health as part of the health care system recommendations that will be presented to the Governors at the end of 2015. We can’t afford to drag our feet any longer.