PEER SUPPORT FOR SUBSTANCE USE DISORDERS: THE FUTURE IN KENTUCKY

Carol McDaidCapitol Decisions, Inc.October 8, 2013

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When are peer recovery support services delivered?

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Across the full continuum of the recovery process: Prior to treatment During treatment Doctor’s Office Post treatment In lieu of treatment

Where are they delivered today?

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Recovery community centers Faith and community-based organizations Recovery homes and sober housing Emergency departments Addiction and mental health service agencies Jails and prisons Probation and parole programs Drug courts HIV/AIDs and other health and social service centers Children, youth, and family service agencies

Where else will they be delivered?

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Trauma centers Primary care practices Patient-centered medical homes Federally Qualified Health Centers Accountable Care Organizations Community mental health centers Community-based alternatives to jails and

prisons Schools & colleges

Who is paying for peer recovery services?

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Medicaid State, county & municipal service

contracts Private pay Federal and state grants As of May 2008:

30 states developed criteria for peer specialists1

14 states have accessed Medicaid reimbursement for peer-delivered mental health and/or addiction services2

Sources:1 http://gainscenter.samhsa.gov/peer_resources/pdfs/Davidson_Rowe_Peersupport.pdf2 http://www.dsgonline.com/RTP/2011.weekly/2011.06.09/WH.2011.06.09.html

Why are peer recovery supports critical in the modern health care system?6

Population changes Increase in population diversity & younger cohorts of individuals from

low-income families Hispanic population increased 43% between 2000 and 2010 Increase in elderly population (87 million by 2050)

Cultural understanding is essential Managing population health requires community education Provider shortages Health system is increasingly complex; peers provide navigation

& advocacy to underserved & vulnerable populations Individuals with behavioral health conditions remain uninsured

even with near universal access to insurance In MA, average number of uninsured is 2%; average rate of uninsured

with MH/SUDs is 16%

7How can addiction recovery coaches advance the goals of parity & ACA?

ACA & Parity Background

The Affordable Care Act (ACA) and the Mental Health Parity and Addiction Equity Act (MHPAEA) present opportunities for recovery coaches regardless of locale

Enroll individuals in exchanges & Medicaid expansion (ME)

Advocacy for coverage & reimbursement of peer recovery support services (PRSS) in state exchange & ME

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The Opportunity

Parity & ACA provide opportunities for delivering & receiving peer-provided recovery support services (PRSS) Approximately 30 m Americans without coverage today

expected to receive it under state exchanges or Medicaid Expansion

Medicaid expansion for childless young adults up to 133% of poverty

11 m of the currently uninsured population below 400% of poverty have MH/SUDs

Specific strategies & tactics are needed to capitalize on this opportunity

How do recovery coaches take advantage? Will we let others capitalize on this opportunity?

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Medicaid Expansion & Exchange Enrollment Strategies• When available, use FAVOR’s

ACA enrollment training curriculum for peers & volunteers

• Arm outreach staff w/the right tools (Medicaid & exchange program manuals, outreach event materials, cell phone etc)

• Develop an enrollment plan (who, how many, by when?)

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PRSS Advocacy Strategies & Tactics Develop relationship w/state

Medicaid director & meet with him/her to share info & data about recovery supports

Host webinar to educate local advocates on new rights and benefits

Meet with/write to insurance commissioner asking re parity guidance to health plans in state

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Use Parity to Include PRSS in Exchange & Medicaid Expansion• Contact CMS if state is not

implementing parity• Send consumers to

www.parityispersonal.org for information on how to appeal denied claim

• Educate exchange & ME decision-makers that MHPAEA requires that PRSS must be included in exchange if other med/surg supports are covered

• Seek inclusion of exchange/ME parity audit provision in state law or regs

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Questions?

Carol McDaidcmcdaid@capitoldecisions.com

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