New Hampshire to launch Medicaid demonstration project

New Hampshire recently received a federal Centers of Medicare and Medicaid waiver for $150 million to help transform the state’s behavioral health delivery system.

In early January, the agency approved New Hampshire’s application for a new five-year Medicaid demonstration project entitled, “Building Capacity for Transformation.”

“This is an unparalleled opportunity for the state to pursue the triple aim of better care, better health and lower health care costs,” said Deborah H. Fournier, Esq., senior health care policy specialist, N.H. Department of Health and Human Services.

“New Hampshire recognizes that addressing the substance use disorder and opioid crisis we are experiencing must be one of our top priorities and the DSRIP [Delivery System Reform Incentive Payment] waiver is an additional arrow in our quiver for doing so.”

The waiver, which is scheduled to be paid out in $30 million increments over the course of the project, will be used to create regionally-based Integrated Delivery Networks (IDNs).

IDNs are collaborations between behavioral health care, health care and community service providers. The waiver plan’s overall goal is to shore up behavioral health and substance abuse care systems, create greater integration with primary care and lower costs in the long-term for the state in providing services.

Each of the IDNs will be asked to create a detailed plan for improving care coordination that will, as a result, expand provider capacity, reduce gaps in care and integrate physical and mental health services, all while projecting cost savings once the program is up and running. IDNs will be asked to set and to meet project milestones in order to receive the incentive payments.

The money, designed to be a “matching  waiver” will be backed by spending at the state level using, what the CMS calls, “alternative payment methodologies” as well with a goal of having each of the new initiatives fully operational once the five-year waiver program is complete.

“The state is leveraging federal match for existing state investments in health care,” said Fournier. “The alternative payment methodologies will be those that move us toward reimbursing for outcomes, high quality care and containing health care costs.”

With rising issues of opioid abuse that have reached crisis levels over the past few years, the state is facing an uphill battle to combat drug overdoses, one that has raised concern from politicians, the general populace and state agencies.

This waiver program is occurring in conjunction with an expansion in Medicaid to offer coverage for substance use disorder to a larger component of the Medicaid population by 2017.

“Our strained mental health system and the heroin and substance abuse crisis are urgent public health and safety challenges facing our state, and demand for mental health and substance abuse – which frequently co-occur – services is increasing,” New Hampshire Governor Maggie Hassan said. “It is critical that behavioral health provider capacity is positioned to effectively deliver the integrated care that our residents need. The approval of this waiver is an important step forward for a New Hampshire-specific solution.”