A New Frontier for Alaska: Expanding Behavioral Health Services through Medicaid

By Carol Backstrom, Principal and Director, Delivery System Transformation

On January 31, the Alaska Department of Health and Social Services (DHSS) submitted a Section 1115 waiver application to the federal Centers for Medicare & Medicaid Services (CMS) that will create a data-driven, integrated behavioral health system of care for Alaskans with serious mental illness, severe emotional disturbance, and/or substance use disorders. Harbage Consulting is proud to continue our work to assist Alaska and other states in improving the behavioral health and substance use disorder (SUD) continuum of care for their Medicaid populations.

Behavioral health challenges often stem from childhood trauma and other adverse experiences that have downstream effects on entire families. Despite Alaska’s relatively small population of 735,600, two thirds report having an adverse childhood experience, and between 20 and 30 percent of Alaskans report growing up in households experiencing mental health and/or substance use issues. These experiences often translate to higher costs associated with acute care and chronic health needs that can span months and even years. Alaska’s proposal aims to establish networks of support for individuals with these complex health needs and their family members.

The state’s waiver proposal focuses on establishing an enhanced set of benefits for three target populations of Medicaid enrollees:

1) Children, adolescents and their parents or caretakers with, or at risk of, mental health and substance use disorders;

2) Transitional age youth and adults with acute mental health needs; and

3) Adolescents and adults with substance use disorders.

Under the demonstration, Alaska would implement a series of proposed strategies and evidence-based interventions aimed at more effectively addressing the needs of each of the target populations. The benefits package is designed to decrease use of acute, costly services by conducting universal screenings; intervening early, when symptoms are first identified; utilizing sub-acute, community-based step-up/step-down clinical services as alternatives to residential and inpatient services; and developing community-based supports to establish and sustain recovery, health, and wellness.

Through this Section 1115 waiver proposal, the state will develop and implement an integrated, fiscally sustainable system of care that achieves the Triple Aim of improved patient experience, improved population health, and reduced costs as well as improved behavioral health outcomes for Alaskans.

Alaska joins nearly a dozen other states, including West Virginia, that have requested or received approval for a Section 1115 waiver to help leverage the Medicaid program to combat substance use disorder issues in their state. Stay tuned for an implementation update from our work on California’s Drug-Medi-Cal Organized Delivery System (DMC-ODS), the first state in the nation to receive approval for an 1115 waiver to address the opioid crisis.