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Medicaid rule will let mental health funding continue

By Keith Whitcomb Jr. [email protected]
Because of a decision made by the Centers for Medicare and Medicaid Services, Vermont won’t have to find a way to replace $13 million used for certain mental health services.

Gov. Phil Scott announced Monday that CMS approved an amendment to Vermont’s “Global Commitment to Health Waiver” allowing normal Medicaid funds to pay for short-term treatment for serious mental illness or serious emotional disturbance at institutions for mental disease.

Ena Backus, director of Health Care Reform at the Vermont Agency of Human Services, said in a Wednesday interview that the Global Commitment to Health Waiver allowed Vermont to use Medicaid funding in a way the Medicaid program normally wouldn’t allow. It let the state tap Medicaid funding sources known as “investments,” which pay for things not normally associated with health care, but if implemented would drive health care spending down.

“The reason why this waiver is important is because the federal government, in our last waiver negotiation for the current period that we’re in, said to Vermont, you need to start planning now for the eventuality in your next waiver, not the waiver we’re in, that you can no longer use investment dollars for institutes for mental disease.”

That would leave the state looking for another pot of money to fund those payments, she said.

“Vermont’s Global Commitment to Health Waiver was first approved in 2005 and is on a five-year cycle and has been renewed at those increments since 2005,” she said. Had this amendment not gone through, Vermont would have had to “phase-down” its investment spending on institutes for mental disease.

Backus said the state hasn’t gained any funds, but neither has it lost any with this decision. Other states can now, likewise, apply for such an amendment. Backus said Vermont was among the few states, if not the only one, using CMS investments in this fashion.

The state uses $40 million in CMS investment funds, she said. They’ve helped with the WIC program as well as a lab used by the Department of Health to test water for diseases, among other things.

Along with the amendment being approved, CMS approved Vermont’s “Implementation Plan,” which aims to reduce the instances of hospital emergency rooms being used to treat mental health issues.

Sarah Squirrel, commissioner of the Vermont Department of Mental Health, said both the amendment and plan approval are wins for Vermont as together they’ll improve the mental health system’s capacity.

“This amendment, in a lot of ways, gives us room to continue to improve our whole-person system of care,” Mike Smith, secretary of the Agency of Human Services, in a release. “Our waiver with the federal government allows us to use a certain portion of our Medicaid funding to make investments we think will increase health and help reduce future pressures on the Medicaid program. This new Federal Financial Participation frees up capacity for innovation.”

Scott said in the Monday release that the federal government has been flexible in working with Vermont over Medicaid.

“As health care costs continue to outpace the growth in almost all other sectors — in Vermont and nationally — it’s important we continue our reform efforts and continue to innovate the way we provide and pay for these services,” Scott said.

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