Challenge
In July 2015, the Center for Medicare and Medicaid Services (CMS) announced an opportunity for states to use 1115 waivers to develop streamlined treatment and coordinated care strategies targeting substance use disorders (SUD).
The waiver provides an opportunity for additional federal funding to be used for SUD programs for the state’s Medicaid enrollees. With rampant opioid abuse plaguing its citizens, the state of West Virginia Bureau for Medical Services (BMS) asked BerryDunn to assist in developing such a waiver.
Approach
BerryDunn’s Medicaid consulting team is working with BMS and the state to:
- Develop a comprehensive assessment of the opioid epidemic’s impact across the state by gathering and synthesizing clinical data
- Convene stakeholders from across the state to develop a strategy to serve as the foundation for the waiver
- Assemble the approach, data, and budget neutrality statement into a waiver application for submission to CMS
Expected outcomes
The state’s goal in creating this waiver is to develop a statewide continuum of care to prevent and treat citizen’s SUD. This will be done through:
- Supplementing current Medicaid services to promote SUD treatment
- Integrating initiatives of the Bureau for Behavioral Health and Health Facilities with SUD programs
- Identifying efficiencies and shared resources statewide
- Accessing federal Medicaid funding to supplement existing State funding
Long-term value
The state of West Virginia and its citizens will benefit from the SUD waiver through:
- Increased access to treatment services
- Reduction of emergency department costs
- Improved care coordination
- Improved health outcomes and quality of life
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