1. General Assistance – UnemployableExperience in WA state July 2010

2. About Community Health Plan of Washington (CHP) • Founded in 1992 by community health centers • Provider network and health plan • Mission-oriented • CHP is a not-for-profit health care services contractor • Our primary mission is to increase access to care for underserved and vulnerable populations. • Network serves over 650,000 patients • Health plan covers 270,000 patients

3. CHPW Network

4. CHP Current Programs • Healthy Options/S-CHIP/S-Women ~ 202,800 • General Assistance Unemployable (GA-U) ~15,400 • Basic Health Plan (subsidized) ~ 45,200 • Washington Health Plan (BHP non-subsidized) starting 7/1/2010 ~ <500 • Medicare Advantage ~ 5,000 • Special Needs Population (SNP) • Urban and Rural plans • With Pharmacy coverage

5. Program Description GA-U General Assistance-Unemployable State-funded medical benefits for persons who are physically and/or mentally incapacitated and unemployable for more than 90 days and who do not have dependent children

6. GA-U Managed Medical Care Pilot Started Dec. 1, 2003 in King and Pierce counties Goals: • Increase number of clients exiting public assistance • Increase number of clients transitioning to SSI • Decrease unnecessary ER visits • Decrease unnecessary hospital admissions and readmissions • Improve pharmacy management • Cost neutral

7. Managed Medical Care Savings

8. Complexityof GA-U Population DSHS | GA-U Clients: Challenges and OpportunitiesAugust 2006

9. Most common Dx and Rx

10. Utilization Trends • Medical costs account for half of DSHS spending on GA-U clients. • Mental illness and substance abuse increase frequency of ER visits. • 50% of all clients qualify for long term disability (SSI) • GA-U clients haven’t historically had a Health Care Home Per enrollee

11. Integrated Mental Health Program Background: 2007 • Integrated mental health benefit added to medical pilot 2009 • Expanded to GA-U statewide in November • Expanded integrated model to additional populations in King County (HO mothers, uninsured veterans, older adults) • State reduced biennial funding 20% ($40 million) • State signed exclusive contract with CHP

12. Integrated Mental Health Program Program Benefits: • Provide integrated Health Care Home for complex populations. • Provide significant relief for primary care providers by providing care coordinator, consulting psychiatrist (MHIP), and funded mental health referrals • Track (real-time) for active case management and care coordination through the use of a client registry across silos (Mental Health Integrated Tracking System: MHITS)

13. Integrated Mental Health Program Program Goals: • To achieve better health outcomes and contain costs by maximizing care coordination, high-risk case management and chronic care management. • To more quickly transition GA-U clients back to employment services, gainful employment or more stable, federally funded programs (e.g. GA-X/SSI).

14. Breaking Down the Silos • Client centered care (vs.) agency centered care PrimaryCare Other Community based Social Services Alcohol & Substance Abuse Treatment SocialServices Vocational Rehab Community Mental Health Centers

15. GA-U Integrated Mental Health Program Specialty Mental Health-CMHC PCP GA-U Client Refer to Community Service Office Consulting Psychiatrists Care Coordinator Refer to Voc Rehab Other clinic-based mental health providers* Refer to Chem Dep Treatment Level I Care (Primary Care) * Available in some clinics

16. http://integratedcare-nw.org

17. Progress to Date • Increase Access: • Over 17, 000 clients seen statewide as of June 2010 • 20% of clients in primary care mental health coordination • Increase assessment and treatment: • 80% of clients screened for depression • 46% screened for anxiety • 45% screened for substance abuse • Increase Outcomes: • 38% of clients with at least two depression scores showed significant improvement in depression symptoms. • 49% percent of clients with severe depression and at least two scores show significant improvement • 85% of clients transitioned to GA-X successfully

18. Next Steps for GA-U Program • Protect program from elimination (State budget deficit) • Opportunities for federal funding through waiver • Pilot integrating housing vouchers in 3 counties • 2010 legislative changes to GA-U program: • Name changed to Disability Lifeline • Limits of 24 months eligibility within the last 60 months • CHP will more quickly identify members for federal Medicaid programs by: • Screening clients within 30 days of eligibility • Improving access to incapacity exams • Improving provider satisfaction through the redesign of the incapacity evaluation process • Improving process for effective transition from GAX and SSI

19. Criteria for Success with Expansion Populations • Incorporate model into Medicaid for at risk populations • Payments based on severity • Integrate silos with payment methodology. Focus resources to one accountable agency/person • Expand state capacity to transition client to highest level of functioning (employment, employ. services, SSI) • Bend the cost curve; track, measure and report