Healthcare providers are becoming increasingly concerned about suggestions by President-elect Donald Trump and GOP proposals that would transform Medicaid into a block grant model. Today, the program is operated as a federal and state partnership with the federal government funding about 57% of the costs.

Such a model would place absolute limits on federal outlays and make its spending more predictable. Some advocates fear the fundamental change in the program's structure would result in less funding in the future, causing a reduction in health services and/or cost shifting to states, counties and consumers. According to the  Commonwealth Fund, some 73 million people have Medicaid coverage currently-the majority are children-and 80% of the program is administered by contracted managed care organizations.

Brian Bowden, associate legislative director of health for the  National Association of Counties (NACo), says any potential Medicaid changes could be critical for behavioral health providers because the program funds the largest share of delivered services in mental health and addiction treatment.

He says Medicaid is currently designed to allow the federal government's matching funds to follow the need, while a block grant could limit that responsiveness.  Read more here.

"I wasn't using it to get high," she said. "I was using it to survive."

Homeless, uninsured and addicted to heroin, Hurteau, a New Hampshire resident, had tried and failed to get help. Services came at a price she couldn't afford.

But in 2014, Hurteau's home state of New Hampshire expanded Medicaid. She qualified for coverage, giving her access to intensive outpatient treatment through the county's drug court program.

New Hampshire, along with 30 other states and the District of Columbia,  expanded eligibility for the state-federal low-income health insurance program under the Affordable Care Act. Hurteau is among the 1.6 million Americans who since then have had access to substance abuse services.

But a  study published Monday in the journal Health Affairs found significant disparities in coverage among the states.  

Read more here .

He had to see a doctor. He had only a month's worth of pills to control his delusions and mania. He was desperate for insurance coverage.

But the state failed to enroll him in Medicaid, although under the Affordable Care Act Indiana had expanded the health insurance program to include most ex-inmates. Left to navigate an unwieldy bureaucracy on his own, he came within days of running out of the pills that ground him in reality.

"I have a serious mental disorder, which is what caused me to commit my crime in the first place," said Ernest, who asked reporters to use only his middle name to protect his privacy. "Somebody should have been pretty concerned."

The health law was supposed to connect Ernest and almost all other ex-prisoners for the first time to Medicaid coverage for the poor, cutting expensive visits to the emergency room, improving their prospects of rejoining society and reducing the risk of spreading communicable diseases that flourish in prisons.

But Ernest's experience is repeated millions of times across the country, an examination by The Marshall Project and Kaiser Health News shows.   Read more  here .

BUFFALO - The Mental Health Association of Erie County Inc. and the Erie County Council for the Prevention of Alcohol and Substance Abuse held a media event to officially launch JustTellOne.org, a public awareness campaign to promote mental, emotional and behavioral health throughout the eight counties of western New York.

As the former chief executive officer of a community mental health center (CMHC), it got me thinking about the many challenges facing provider organizations as part of this conversation. While CMHC executives have long believed that the fee-for-service payment system was not a sustainable model for serving the most ill individuals, I'm not sure that the leap to value-based contracts will be seen as a solution - at least not immediately.

First, there is the concern about the "performance" side of the value-based reimbursement. Many behavioral health providers, including community mental health centers, give priority to serving people with serious and disabling behavioral health disorders. Payers and provider organizations have had great difficulty defining "quality."
While standardized behavioral health quality measures are in development, they are not yet uniformly recognized in the professional community. And, payer performance metrics are often geared to client populations with less severe disorders and may penalize providers serving a disproportionately more disadvantaged population.  Read more  here.