Cost and Financing

In the face of the devastating opioid crisis, states are confronted with financing and regulating complex -- and often disconnected -- systems of services to treat opioid use disorder. A comprehensive, sustainable service system must include a robust mix of high-quality treatment for acute needs linked to long-term supports for care maintenance with wraparound supports. This session provided an opportunity to hear from state leaders about the keys to creating and financing a high-functioning system to serve people with this disorder and their communities.  

This session was presented in partnership with the Pew Charitable Trusts and their Substance Use Prevention and Treatment Initiative.

The feds are running a demo program that would allow Medicaid reimbursement for inpatient psychiatric hospitalization. Medicaid currently does not reimburse for enrollees ages 21 to 64 for private inpatient psychiatric institutions. Because of this exclusion, enrollees will go to a general hospital’s emergency department. Even though an emergency department may not be equipped to properly treat an individual, they are required to accept everyone by federal law.

Health care spending is 18 percent of the national economy so it is no wonder that big health issues face the states in 2014. The all-consuming question for states is how to contain costs. The Affordable Care Act kicks in full force in 2014 and states that haven't already decided to expand Medicaid eligibility may take up the question. The health marketplaces, while slow to start in October, were making more headway as 2014 began. Nearly 4 million (3.9) individuals had been deemed Medicaid or CHIP eligible and another 2.1 million selected private health insurance policies through the federal or state marketplaces by the end of December 2013. States will look at systems and delivery methods, including mental health, aging and professional scope of practice issues. 

For all the talk about mental health services as one of the preventive factors for violence like the Newtown, Conn. school shooting, new federal data give us insight into the barriers to receiving these services. Fifty percent of adults who had an unmet need for mental health care in 2011 said they could not afford the cost of that care.

The CSG webinar “Medicaid Managed Care: Asking the Right Questions,” broadcast on January 12, 2012, addressed one way policymakers are looking to bend the Medicaid cost curve. States are using managed care to cover about two-thirds of all Medicaid members.

CSG Research & Expertise in the News: Week of 5/29-6/4, 2011

The following compilation features published news stories during the week of May 29-June 4 that highlight experts and/or research from The Council of State Governments. For more information about any of the experts or programs discussed, please contact CSG at (800) 800-1910 and you will be directed to the appropriate staff.  Members of the press should call (859) 244-8246.

The majority of state Medicaid programs are testing models of coordinated medical care to improve quality and reduce costs, particularly for patients with multiple chronic illnesses.  Patient-centered medical homes are similar to managed care approaches and health maintenance organizations, but ask providers to focus on improving care rather than managing costs. Such medical homes focus on improving the relationship between doctors and patients, aim to put the patient at the center of the care system, and provide coordinated and integrated care over time and across care settings. Descriptions of eleven states’ pilot programs or authorizing legislation are included.

Ten state legislatures have formed caucuses to educate legislators about  mental health policy issues.  Through these caucuses legislators and mental health champions work together on a variety of state mental health issues, such as funding, coverage and access and criminal justice.