Medicaid Unwinding and State Behavioral Health in Montana, Minnesota, New York, Arizona, Colorado, Tennessee, and Washington

Nearly 40% of Medicaid enrollees meet diagnostic criteria for a mental or behavioral health condition. As federal requirements to retain all Medicaid enrollees during the pandemic begin to fade or “unwind,” it’s the states themselves that have control over the fate of millions of Medicaid enrollments. 

Let’s look at how these changes are playing out in 7 key states: Montana, Minnesota, New York, Arizona, Colorado, Tennessee, and Washington. 

Montana: State Medicaid Updates During the Unwinding of Continuous Enrollment

Medicaid enrollment in Montana flourished during the pandemic and the continuous enrollment period. 

Historically, Montana has a bad track record for Medicaid accessibility. The state denies more applications than most, so it’s expected that the unwinding process in Montana will result in many uninsured residents. States have 12-14 months to complete the “unwinding” process, but Montana has decided on a 10 - 12 month “unwinding” or reprocessing of Medicaid eligibility. 

Montana’s Department of Public Health and Human Services began checking for Medicaid eligibility in April 2023. 

Minnesota State: Unwinding Updates for the Phase-Down of Continuous Enrollment

Minnesota released its “Plan to Unwind Continuous Eligibility Coverage” in February 2023. It outlines the history of pandemic-era changes as well as effects on enrollment and then goes on to name challenges to name “renewal challenges” like budgetary constraints, workforce problems and other barriers to state-provided health coverage. 

The plan provides useful details for those anticipating possible changes to their enrollment eligibility. Eligibility will be reprocessed according to the month in which enrollee’s initially applied. They will begin with those who first enrolled in the month of July. Those enrollees will see a determination made beginning sometime in March 2023. MinnesotaCare renewals are slated for quarter 4 of fiscal year 2023.

New York State: A Three Phase Medicaid Unwinding Plan

New York state has created a toolkit to help New Yorkers understand the unwinding process and navigate health care in the post-COVID world. 

New York’s unwinding plan is a three phase one: first, they’ll spread awareness of important coming changes to Medicaid. Second, they’ll help every enrollee update their contact information with the state so that they can communicate renewal information effectively with individual enrollees. Third, they’ll help New Yorkers through the redetermination process and/or help former enrollees migrate to more appropriate coverage.

Arizona: 600,000 Medicaid Patients At Risk of Losing Coverage During Unwinding

Arizona began the Medicaid unwinding process in April 2023. 

Arizona Health Care Cost Containment System AHCCCS maintains a dashboard containing all the states’ information on this post-COVID change. According to a useful factsheet for Medicaid unwinding in Arizona, more than 600,000 members are at risk of losing their Medicaid and/or KidsCare coverage in the state, due to redetermination criteria and invalid personal contact information.

Colorado: About 80% of Members Should Remain After Medicaid Unwinding

Colorado’s Medicaid program swelled by up to 500,000 new members during the pandemic but it is slated to shed quite a few of those new additions soon. 

The state has gone on record saying that it believes that roughly 80% of current Medicaid enrollees will remain after the great disenrollment program is complete. That said, “hundreds of thousands” of enrollees could lose their Medicaid coverage - whether that’s Health First Colorado, or CHP+, the Child Health Plan Plus - during the unwinding process as it’s slated in Colorado. 

Tennessee: Medicaid Unwinding Likely to be Catastrophic for Many in This Non-Expansion State 

Along with Wyoming, Texas, Kansas, Wisconsin, Mississippi, Alabama, Georgia, Florida, and South Carolina, Tennessee is one of the 10 states in the union that has not adopted the ACA Medicaid expansion. That means that enrollees in this state are vulnerable to a “coverage gap” where poverty-level residents may not be “poor enough” to qualify for the state’s ultra-low Medicaid income requirements but “too poor” to qualify for ACA marketplace coverage subsidies. This is a policy issue where the state is essentially signaling they believe the federal government should cover these individuals, while the federal government is signaling the opposite - that the state should pick up the bill.

This makes Tennessee’s Medicaid unwinding plan to be a highly disruptive one for many vulnerable people in Tennessee.  

Washington State: Medicaid Unwinding Likely to be Less Brutal in This Medicaid Expansion Early Adopter

Washington state, like most other states, saw a huge growth in the number of Medicaid enrollees during the pandemic, in part due to Medicaid expansion. The state was an early adopter of Medicaid expansion in 2014. Currently, Apple Health (Washington’s name for its Medicaid program) ensures well over 2 million people. Those individuals with incomes that have shifted below 138% of the federal poverty level will soon lose their coverage due to the Medicaid unwinding process now underway in the state. 

Working to Understand Medicaid Unwinding in Your State? Behave Health is Here to Help.

Behave Health is committed to making it easier - and more profitable - to operate evidence-based, results-focused addiction treatment centers.

Our all-in-one app puts clinical, administration, staff, admissions, alumni, residents, treatment plans, billing, insurance authorizations and more - all at your fingertips.

Get your free trial started today and see why more addiction treatment centers prefer Behave Health.

PS. Just getting started with behavioral health? Need help with certification, too? Behave Health can also help direct you to the right resources for help with Licensing or Accreditation by either The Joint Commission or CARF. Mention to your product specialist that you’re interested in this service after you start your free trial!

How is Your Addiction Treatment Center Preparing for a Post-COVID World?

COVID-19 has created a perfect storm in the addiction treatment world. It seems these days we are being hammered from all sides: economic uncertainty, political (and policy) uncertainty and, of course, uncertainty about the course of the novel coronavirus itself. While all studies being done currently point to a massive surge in substance abuse in the United States, overall admissions in treatment are down as social isolation and concerns about safety erect new barriers to treatment. Some surveys are finding that 64% of addiction treatment centers are currently reporting revenue losses directly tied to the pandemic.

We’ve written extensively here about what you can do at your addiction treatment center to address the pandemic from a public health and economic health perspective. Certainly many readers are preoccupied with the day-to-day of responding to the crisis at hand as it continues to evolve. 

It’s hard to think outside of this moment, but, as businesspeople, it’s important that we try. 

Ask yourself: what happens next? What happens after COVID-19 is finally “over” (or at least more managed) and life no longer revolves around mitigating the risks associated with this virus? 

What is your addiction treatment center doing to prepare for the post-COVID world? 

 Today, we’ll look at 4 things that appear to be on the horizon for the addiction treatment community and give you suggestions on what your organization might begin to do to prepare for what comes next.

Addiction Treatment Post-COVID Reality #1: Telehealth Is Here to Stay 

In the wake of the pandemic, the vast majority of our readers have shifted their addiction treatment centers to rely heavily on telehealth services. Many of you are still offering in-person services, of course, and in some instances that level of care is absolutely necessary. But for those patients where telehealth is appropriate, it makes sense to improve social distancing for staff and patients by keeping unnecessary visits down. 

The US Department of Health and Human Services renewed their COVID-19 emergency declaration for a third time last month, extending changed Medicare and Medicaid rules that allow for the reimbursement of telehealth services for members of those programs. Private insurers have also shifted to embracing telehealth coverage for patients during the pandemic. 

Within the addiction treatment community, the migration to telehealth happened quickly in response to the pandemic, despite an historic resistance to pivoting away from face-to-face care. Despite concerns, most addiction treatment centers have seen no decrease in productivity or program effectiveness. Many have reported a marked decrease in no-shows. 

It is reasonable to expect the trend towards telehealth to continue after COVID-19 as patients and providers gain a level of comfort with the modality. 

If your facility is struggling with telehealth delivery, now is the time to address that problem. Be sure that your addiction treatment center is set up with the best EHR to handle the job. 

Addiction Treatment Post-COVID Reality #2: National Trauma and Delayed Care Means a Tsunami of SUD Patients 

It doesn’t take an addiction treatment professional to know that the national stress and trauma of the COVID-19 pandemic - as well as the economic and political stress that goes along with it - will cause more people to turn to drugs of abuse than ever before. Research is already proving that rates of addiction are skyrocketing in response to the difficulties we are all experiencing right now. What’s more, people in recovery are finding themselves relapsing as the routines and support structures they rely on are compromised by the pandemic.

It’s clear that we can expect a huge wave of addiction treatment patients in the near-future.

For addiction treatment centers, that means planning for a huge influx of patients at a time when cash flow is slowing to a trickle. It’s an impossible position. 

What low-cost improvements can your organization make right now to help prepare for that eventual bump in admissions? When making new hires and acquiring new properties is out of the question, focus on tightening up what you already have. Updating your software is a great way to improve efficiency and productivity without investing too much capital. 

Addiction Treatment Post-COVID Reality #3: Demand for MAT WIll be at an All-Time High

As restrictions around Suboxone and Methadone have loosened, patients are proving that they can handle the responsibility of take-home medications, despite the risks of diversion and abuse. Now that MAT patients - and providers - are growing accustomed to skipping the frequent (if not daily) in-clinic visits, it will be very difficult to go back to the older, more strict MAT rules. It seems likely that this is the “new normal” when it comes to MAT. With the rules relaxed and barriers removed, it makes sense that more patients will flock to these evidence-based medicines to help with their opioid addiction.  

If your addiction treatment program shuns MAT patients and relies on an abstinence-only method, now is the time to reconsider your approach. While many organizations still rely on this older approach to recovery, it would be reckless to fail to notice that the tide is turning. 

Addiction Treatment Post-COVID Reality #4: More States Decriminalizing Drugs Means Fewer Court-Mandated Patients 

Oregon just voted to decriminalize possession of all drugs of abuse. Though it’s the only state in the union to do so, the Drug Policy Alliance, the national non-profit behind the Oregon measure, has its eyes set on passing more legislation to decriminalize drugs throughout our country. Regardless of what you believe personally about decriminalization, the effects on the addiction treatment industry remain the same. 

In states that legalize drugs, we will see fewer court-ordered treatment patients. 

For addiction treatment centers that rely heavily on the justice system for new admissions, these changes could be existential. 

If this describes your addiction treatment organization, begin thinking now about how you will pivot in response to this change. It could mean improving your outreach efforts to certain communities, planning to invest in advertising campaigns or shifting your focus to a different niche within addiction treatment. Keep an eye out for developments in your state and plan accordingly.

We’re Here To Help 

At BehaveHealth, we are committed to supporting the addiction treatment community through this turbulent time. Our cloud-based software solution is designed especially for addiction treatment providers just like you. We continue to update our software in response to the changing treatment environment so that you can forget about the tech and focus on providing the best care possible to your patients. Claim your free trial to see how we can help your addiction treatment organization thrive today.

ASAM Released New COVID-19 Guidelines for Addiction Treatment Providers. Here's the Highlights.

On September 19th, ASAM (American Society of Addiction Medicine) announced their new pandemic guidelines for providers. Their “Caring for Patients During COVID-19 Task Force” created the guidelines as an expansion of pre-existing recommendations the agency made to addiction treatment providers earlier on in the pandemic. The new guidelines touch on some old themes but also cover a lot of new ground worth considering, especially in the sections on drug testing protocol and incident command structure.

At Behave Health, we look to industry leaders like ASAM for guidance on how to address COVID-19 in the addiction treatment setting. Today, we’ll cover some of the highlights of the new ASAM guidelines and consider their usefulness for addiction treatment providers during the COVID-19 pandemic. 

ASAM’s New Guidelines for Addiction Treatment Professionals are Pretty Expansive But They’re Not Legally Binding 

The guidelines released in September cover a lot of ground. Broken down into 15 different sections, the guidelines touch on everything from acute hospital settings protocols to clinician wellbeing to online support group etiquette. The website allows you to easily navigate to the sections that are most relevant to your facility’s level(s) of care.

Here’s a few of the ASAM guidelines’ subheadings: 

• Infection mitigation in outpatient settings and residential treatment facilities

• Adjusting drug testing protocols

• Access to care in opioid treatment programs

• Support group participation

• Managing justice-involved persons with addiction

• Ongoing management of the continuum of addiction care

Although ASAM speaks authoritatively on what should - and should not - be going on in addiction treatment centers during the COVID-19 pandemic, they are quick to note in their new guidelines that they are simply for “informational and education purposes” only. ASAM frequently refers readers back to their local health authorities for the final word on how to safely operate addiction treatment centers during the pandemic. They’re careful to note that each safety measure should be considered on a case-by-case basis depending on how severe the outbreak is in any given community.

ASAM’s COVID-19 Pandemic Drug Testing Recommendations for Addiction Treatment Providers are Very Conservative  

One of the biggest changes in ASAM’s new guidelines is its updated approach to drug testing. The society strongly cautions against any routine drug testing that does not have direct consequences for the way addiction treatment providers deliver care to that patient. In other words, if the care plan for the patient would be the same regardless of the results of a test, then ASAM wants you to skip the test. 

In explaining their reasoning for this conservative approach, ASAM points to reports that COVID-19 is infectious in both feces and urine and that redundant testing is not only an unnecessary risk to providers, but also an unneeded strain on laboratory operations that might be already stressed with coronavirus-related work. ASAM also points out that unnecessary drug testing requires the use of scarce PPE and may pose a threat to our already strained medical supply chains.

Instead of traditional urine-based drug testing, ASAM recommends addiction treatment providers investigate more “socially distanced” drug testing options, such as home breathalyzers that can be monitored via telehealth. 

ASAM Recommends Creating an Incident Command Structure for Your Addiction Treatment Center During COVID-19 

ASAM’s new guidelines also call for creating an “worse case scenario” plan for how your addiction treatment center will continue essential operations if one or more of your key staff members falls ill. Called an “incident command structure,” this plan would outline which staff members can take over what essential responsibilities of their colleagues. It’s very similar to the contingency planning we’ve discussed elsewhere on this blog. ASAM also recommends cross-training staff members to perform essential functions ahead of time, to prepare for any unforeseen sick leave and staff shortage. For example, more than one staff member at your addiction treatment center should know how to unlock the doors, disable alarms, and access medicines and emergency supplies.  

We’re Here to Help 

If you feel overwhelmed by ASAM’s new guidelines, you’re not alone. Many addiction treatment professionals are reeling from the vast array of changes COVID-19 has made in our professional lives. The rules of the game have changed - at least temporarily - but we’re helping addiction treatment providers all around the country tame the chaos with smart, simple tools designed especially for the behavioral health community as it exists today. Our pandemic-ready software solution is intuitive, simple, and—as our users like to say—“it just works.” 

Claim your free trial today and see how we can help make this difficult time a whole lot easier for your treatment center business.  

New! Pandemic Management Tools Designed Especially for Addiction Treatment Centers

As part of our Summer 2020 Update, the team at Behave Health is excited to announce the roll out of some thoughtful new tools for managing the pandemic at your addiction and mental health treatment center. 

2020 has thrown quite a lot at the addiction treatment community. The pandemic has tested us in ways we could never expect. We’ve had to try new approaches to connecting with our patients as well as new approaches to keeping our patients safe while in treatment. 

On this blog, we’ve written about how as many as 5% of addiction treatment centers may close by the time the pandemic is over. We’ve also covered the need for treatment centers to pivot to intensive outpatient programs where inpatient programs have been the norm, especially in the areas hit hardest by the pandemic. Many centers are facing business reorganizations spurred by the Small Business Reorganization Act, while others are changing protocols to allow for proper social distancing in their facilities. 

The common thread among all centers right now is CHANGE.

In order to help foster a productive and efficient environment amid all of the chaos, we’ve developed some simple tools to help your center deal with the pandemic and mitigate program risks associated with the Coronavirus. 

Read on to learn about the top three features we’ve added in the Summer 2020 Update that can help your center thrive during these difficult times.

We’ve Included COVID-19 Questions on the Addiction Treatment Application Form 

Now your organization can easily screen new admits for COVID-19 risk factors when they fill out our customizable online application. 

Accessible from any device at any time, our cloud-based application allows your new admits to initiate treatment without waiting. We know that it’s vitally important to be ready and available for patients in moments of willingness to change - and we know that those windows of opportunity can be fleeting. Our online application lets new admits complete their application from their phone at any time, day or night, removing one of the key barriers to treatment for every patient. 

Our new application forms’ COVID screen questions include: 

• Are you at risk for exposure to any communicable disease, or have you been in contact with someone who has? 

• Are you experiencing shortness of breath, coughing, fever, or other symptoms of Coronavirus and/or flu?

• Are you at risk for exposure to Coronavirus? 

• Have you traveled outside of the country in the last 30 days? 

Taking Temps to Screen for COVID at your Addiction Treatment Center? We’ve Got You Covered 

Our Summer 2020 Update makes it easy to include temperature information on the Vital Signs portion of every patient’s EHR. No more scattered sticky notes with temperature logs. Access all of your temperature information in one place, alongside all other vital signs where it belongs. 

We’ve Added COVID-19 Test Results to Our Communicable Disease Testing Roster 

Sometimes things that should be simple aren’t simple at all. A lot of EHR users complain that there’s nowhere to add COVID-19 test results in their EHR because the test is new. There’s just no “box” to put the information. What ends up happening is that clinicians add results in the “comments” or “notes” section of whatever program they were using to record health information. The result? Inconsistent records and a lot of aggravation. 

Our Summer 2020 Update is determined to get you to stop hiding COVID-19 test results in your EHR. We’ve added COVID-19 testing to our communicable disease test section. Simply add the date of the test and the result - positive or negative - and extra comments you may have about the test. There’s also room to add an attachment - like an official test result print out - to the COVID-19 test result record. 

Simple, clean, easy.

Behave Health: We’re Here to Help Your Addiction Treatment Center Succeed

As always, we at Behave Health take our lead from you - our users in the addiction treatment and behavioral health treatment community. 

Have we missed something? Got a suggestion? It’s our mission to make life easier for the addiction treatment community, so let us know how we can help! 

Not a Behave Health user yet? We’d love to show you how our all-in-one software solution can help save your addiction treatment center time and money. Claim your free trial today.