On January 15, 2011, the Governor released her proposed budget for next fiscal year, which begins July 1, 2011. Our part of the budget in the link above is on pages 105 through 111.  You kinda need to be a budgeteer to understand some of it, so I’ll try to distill it down a little in several posts this week.

Changes to Medicaid

The proposed budget reduction that would have the largest impact to our mission is a proposal to temporarily (for 2 years) roll back a portion of the population (called childless adults) that are currently covered for Medicaid (AHCCCS) healthcare benefits (beginning October 1, 2011).  “Childless adults” refers to people who haven’t had kids or who had kids but the kids are grown (e.g. “empty nesters”).  Currently we’re one of a handful of states that cover childless adults all the way up to the 100% of federal poverty threshold.

The State would need to get permission from the federal government in order to temporarily drop this population from coverage under AHCCCS, so whether this actually happens or not will depend on what the US Department of Health and Human Services says.  The legislature took action in a special session last week that instructs the Executive branch to pursue a waiver to change eligibility levels.  Also, the Governor is pursuing congressional changes to give states more flexibility in this regard.

We currently provide behavioral health services to approximately 5,200 childless adults that have a serious mental illness. While it may appear, and we were originally concerned, that this would mean that childless adults with a serious mental illness may lose their current benefits if the proposal is implemented, we think there’s a way to ensure that more than 80% of these folks can maintain their current benefits under a different Medicaid category.

We believe that most of the childless adults that have a serious mental illness and are currently receiving services from the ADHS could still qualify for their full benefits including behavioral health services under a different federal category for the disabled (called Supplemental Security Income Medical Assistance Only). Qualifying for this new category requires a review of each person’s medical condition to see whether they meet the standard. We believe that more than 80% of the childless adults with a serious mental illness that are receiving behavioral health services can qualify under the Supplemental Security Income Medical Assistance Only category. This means they would maintain their current benefits.

In order to help these individuals retain coverage, we’ve instructed our Regional Behavioral Health Authorities (RBHAs) and our behavioral health providers to immediately implement a coordinated approach to screen every single childless adult with a serious mental illness that is currently receiving services from the ADHS for eligibility under the Supplemental Security Income Medical Assistance Only.  Just in case, the proposed budget includes extra funding to make sure that people with serious mental illnesses who don’t qualify for SSI Medical Assistance Only would still be able to keep their prescriptions for their illness.

Childless adults that currently receive general mental health services from our RBHAs through Medicaid would have their benefits suspended beginning October 2011 under the proposal, saving about $79M of general fund next fiscal year and our budget is reduced by that amount under the plan.