DMAS Biennial Report Working Draft1

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PEOPLE WITH DISABILITIES WHO WE HELP Community Living The elderly or disabled with consumer direction (EDCD) home and community-based waiver is intended to allow Medicaid enrollees who meet nursing facility level of care criteria to receive care in the community rather than in a nursing facility. Covered services include adult day health care, personal care services, personal emergency response system, respite services and transition services. Consumer- directed is a service delivery model of care. Individuals in the Intellectual Disability (ID) Waiver, Individual and Family Developmental Disabilities Support (DD) Waiver, or the Elderly or Disabled with Consumer Direction (EDCD) Waiver, have the option of CD services if criteria are met. Add #s – long term care emailed Nicole Scott Employment Incentive MEDICAID WORKS is a work incentive opportunity offered by the Virginia Medicaid program for individuals with disabilities who are employed or who want to go to work. MEDICAID WORKS is a Medicaid plan option that will enable workers with disabilities to earn higher income and retain more in savings, or resources, while ensuring continued Medicaid coverage. Intellectual Disability & Developmental Disability Waivers Redesign DMAS partners with the Department of Behavioral Health & Developmental Services (DBHDS) on the Intellectual Disability waiver, Developmental Disability waiver, and Day Support waiver. These waiver programs allow Medicaid enrollees to choose home and community-based care as an alternative to institutionalization. These agencies are working collaboratively to redesign the intellectual disability and developmental disability waivers. This marks an innovative opportunity to evaluate the state’s current service delivery system for individuals with these disabilities and move Virginia towards a more personfocused, needs-based approach. DMAS is working with CMS on the required waiver amendments to launch this redesign in 2017. DISABILITY STORY Add story and quote DID YOU KNOW? FACT Add fact 1 Board of Medical Assistance Services
PEOPLE WITH BEHAVIORAL HEALTH NEEDS Medicaid is the primary payer for behavioral health services in Virginia. Over the past several years, DMAS has strengthened its partnership with the Department of Behavioral Health and Disability Services to enhance the quality of behavioral health services. In addition, DMAS contracted with a Behavioral Health Services Administrator to improve quality, administration and integrity. The Behavioral Health Services Administrator, Magellan of Virginia, serves Governor’s Access Plan (GAP) as a single entity to handle network management (provider enrollment, credentialing, contracting, and development), service authorizations, quality of care, and claims for fee-for-service behavioral health services. Magellan of Virginia also performs comprehensive care coordination and promotes more efficient utilization of services which reduces unnecessary expenditures. A Healthy Virginia Initiatives Behavioral Health Homes WHO WE HELP Working seamlessly with the U.S. Centers for Medicare & Medicaid Services (CMS), DMAS successfully launched the GAP in January 2015. This demonstration provides primary care and behavioral health services for up to 20,000 uninsured , seriously mental ill Virginians with incomes at or below 80% of the Federal Poverty Level. The GAP program increases access to care, and improves physical and behavioral health outcomes. Since inception, GAP has met the medical and behavioral health needs of 9,808 Virginians, many of whom are veterans. DMAS is proud of its ability to engage this difficult to reach population. It is extending outreach to focus on criminal justice re-entry and have developed new community partnerships to support this program. DMAS partnered with five health plans to establish a behavioral health homes pilot program that coordinates care for adults and children enrolled in Medicaid with a diagnosis of serious mental illness or emotional disturbance. The regional pilots are now serving 250 members in Medallion 3.0, and the Commonwealth Coordinated Care health homes are serving 229 members. This effort addresses members’ physical needs and life circumstance to promote compliance with treatment, and prevent hospitalization. MARK’S STORY A 30 year-old Virginia man started working with a GAP Recovery Navigator in February 2016 because of increased depression and isolation. Because of a limited social support system, he preferred to stay at home using social media and on-line gaming to cope with his depression; however, since accessing GAP services, he has started exercising, joined community support groups, and found interest in several activities in the community. “Before I had GAP, it was hard to get the help I needed with my depression but now I’m able to get the medications I need, see a therapist and my doctor. The program is a success in my eyes…and I am thankful for it.” FY15 | 16 Biennial Report 1
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Page 3 and 4: FROM THE DIRECTOR September 15, 201
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Page 9: CYNTHIA’S STORY Cynthia is 58 yea
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Page 15 and 16: New Key Position: Chief Medical Off
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DMAS Biennial Report Working Draft1

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