COLUMBUS, Ohio - State officials are moving forward with plans to better coordinate care for Medicaid beneficiaries with severe mental illness who also face chronic medical issues, such as asthma or diabetes.
Under the proposal, providers would partner with doctors, pharmacists, social workers and others to better address the patients' mental, behavioral and physical health needs.
State health officials said Thursday the new benefit is slated to begin Oct. 1 in Butler, Adams, Scioto, Lawrence and Lucas counties. The remaining counties will be phased in, with all 88 counties providing the service by next July.
Roughly 177,000 state residents could be eligible, but not all are expected to need or choose to get the benefit.
Tracy Plouck, director of the state's Department of Mental Health, said in an interview that the idea is to lower future Medicaid spending on those with serious and persistent mental illness without cutting back their services.
An adult with serious and persistent mental illness costs the program three times more than the typical adult on Medicaid, according to state figures.
The so-called "health homes" benefit aims to get doctors and other health professionals communicating with behavioral health centers about the patients' conditions and ways to improve their health. The idea allows for more sharing of electronic medical records and coordinating among medical professionals, socials workers and others.
For instance, a care manager at a mental health center could help a Medicaid beneficiary who has abscesses in his or her mouth get the much needed dental care. That coordination then leads to better health and likely helps the person avoid possible health complications down the road.
"We're spending for this population in a way that's more much expensive today," Plouck said in an interview. "The thinking is that if we can introduce primary care, we'll be spending in a different way, but hopefully less than we otherwise would have been."
The state expects some savings from the new benefit option, but it's unknown how much. Officials anticipate the model of care will lead to fewer emergency room visits and nursing home and hospital stays.
"If you have an overall healthier population, then you are arguably spending less overtime than if you had a less healthy population," Plouck said.
Reimbursement rates that Ohio and the federal government would pay providers could vary and have yet to be negotiated. But the federal government is expected to cover 90 percent of the reimbursement cost in the first 24 months. That money would help pay for staff consultation and technology upgrades to allow for electronic medical records to be exchanged, among other expenses.
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