CMS approves 1115 waiver for 10 pilot projects, related innovations

CHICAGO (May 7, 2018) – Gov. Bruce Rauner today announced that Illinois has received federal approval to launch a sweeping $2 billion behavioral health initiative designed to deliver better outcomes for Medicaid beneficiaries suffering from mental health and substance abuse disorders.

The Better Care Illinois Behavioral Health Initiative is the culmination of a 30-month long Rauner administration effort to involve state health agencies, legislators and behavioral health organizations in a coordinated plan to help people with disorders that require treatment of the whole person. 

“The Better Care Illinois effort is one the most significant developments in the history of Illinois’ health programs,” Rauner said. “For the first time here in Illinois, we are in a position to devote massive integrated resources to the devastating effects – personal and societal – of behavioral health problems.”

“This effort puts a strong new focus on prevention and public health; pays for value and outcomes rather than volume and services; makes evidence-based and data driven decisions; and moves individuals from institutions to community care, to keep them more closely connected with their families and communities.”

“The waiver will allow the state to care for its most vulnerable citizens earlier and more efficiently,” Rauner continued. “Better Care Illinois will use an integrated approach, so we can focus on helping the whole person and get the right services to the right person in the right setting at the right time.”

The waiver is not a grant but rather an opportunity to use $2 billion Medicaid dollars differently to increase the efficiency and quality of care for Medicaid populations. The state got the go-ahead to launch the initiative from the Centers for Medicare and Medicaid Services (CMS) which approved the state’s application for a 1115 Waiver. 

The waiver means that beginning July 1, 2018, Illinois can begin investing $2 billion of federal funds in 10 pilots to demonstrate better care alternatives and outcomes. The pilots will feature newly created delivery systems designed to improve care, increase the value of patient experiences, and produce better outcomes for the dollar. The federal government has also been approving related innovations called state plan amendments. 

Better Care Illinois is a win for state taxpayers who over time will see better health outcomes without spending more state dollars. The demonstrations will result in more early help for beneficiaries, so savings can eventually be invested in more cost-effective services. More than 750,000 beneficiaries, 25 percent of Illinois’ Medicaid population, have behavioral health conditions, and they account for 52 percent of Medicaid spending.

The application process was led by the Illinois Department of Healthcare and Family Services (HFS), the state’s Medicaid agency. Thirteen state agencies participated in the development of the approved application. 

“The opioid crisis and violence in our communities call on us to find better ways to help those in need, and that is what we are accomplishing with this transformation," said HFS Director Felicia Norwood. “Smarter spending will lead to healthier lives and safer communities. By bringing state agencies and medical providers into closer cooperation for our members, we ensure stronger whole-person care for vulnerable individuals.” 

“There is enormous evidence that treatment for substance use and mental health disorders is effective and that these services help individuals recover and have full lives in their communities,” said Secretary James Dimas of the Illinois Department of Human Services. “Ensuring that people with substance abuse and mental health disorders have access to and receive appropriate evidence-based treatment is critical to solving the state’s opioid crisis and to supporting a strong system of care for those struggling with addiction and mental health problems.”

“The 1115 Waiver will go a long way in improving access to care by allowing Medicaid to pay for critical services that until now have not been reimbursable through Illinois’ Medicaid program,” he said.

According to the Governor, the pilots will help Illinois address a variety of vexing societal problems that are impacted by behavioral disorders: mental health, violence, public safety, and opioid abuse among them.

“Prevention is one dimension of the opioid crisis,” said Lt. Gov. Evelyn Sanguinetti, co-chair of the Governor’s Opioid Task Force. “The other is treatment and recovery. Better Care Illinois gives us some of the tools we need to investigate every possible answer to opioid abuse.”

“CMS applauds Illinois’ efforts in designing this demonstration, as well as its ongoing commitment to improving the health and well-being of Medicaid beneficiaries,” CMS Administrator Seema Verma said in the letter approving the waiver. “CMS is dedicated to empowering states to better serve their beneficiaries through state-led reforms to improve health outcomes. We expect this demonstration to produce compelling results.”

The 10 CMS-approved pilot projects involve a variety of treatment, intervention, case management and home health programs. Summaries of the 10 pilots in the Better Care Illinois Behavioral Health Initiative can be accessed here.

“I would like to thank the Governor for having a real team to be serious about the needs of the people. This waiver is the change we have been waiting for. It is the change in our communities that we have needed. When you bring physical health and mental health together to be integrated we can really help people. So today is the change we need,” said Rep. Lashawn Ford (D-Chicago). “We should see a change in the homeless populations, a change in the people addicted to heroin and opioids and a reduction in the prison population. The Governor has a plan to safely reduce the prison populations and this is part of that plan. So, our communities have been waiting for this. I am so thankful to be here today and am committed to make sure the 1115 waiver works for the people of Illinois.”

“The approval of this waiver provides Illinois with significantly greater flexibility to deliver vital health care services for our most vulnerable population,” said Rep. Patti Bellock (R-Hinsdale). 

“I congratulate the Governor and my colleagues on both sides of the aisle for working together to make this achievement possible on behalf of our seniors; those who suffer from mental illness; individuals living with physical, intellectual or developmental disabilities; medically-fragile children and all who depend upon Medicaid,” said Sen. Heather Steans (D-Chicago). “The 1115 waiver provides desperately needed resources to build out our community behavioral health services. This effort will help Illinoisans receive all their health care needs through a single health home.”

“I want to thank the Governor and his team for putting together a successful federal waiver application, which is never an easy process,” said State Sen. Dave Syverson (R-Rockford). “This waiver will give our state the flexibility necessary to design our mental health programs to serve people better.”

“The waiver allows the state to be more creative in providing Medicaid services that will, in the end, bring down the costs of the Medicaid program and be beneficial for the program's enrollees,” said State Sen. Dale Righter (R-Mattoon). “Thanks to the Governor and his team's leadership, we have a major win for taxpayers and Medicaid participants.”

“This waiver will help strengthen and expand our critical behavioral health infrastructure,” said Rep. Tom Demmer (R-Dixon). “We’ll bring new approaches and new tools to communities across Illinois as we strive to meet the needs of those with mental health and substance use challenges.  I look forward to continuing to work with the administration and with local providers to build an even more robust network throughout the state.”

“The devil is always in the details, but the long-awaited waiver has finally arrived. I look forward to sifting through it to strengthen health care delivery and our safety net,” Rep. Sara Feigenholtz (D-Chicago) concluded.

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