California State University, Northridge Certificate in LGBTQ+ Health

Turn and Face the Change: Children’s Medicaid Redesign

Change is inevitable. Change has and will always be a part of life, but it seems that the last couple of decades have brought about an unprecedented rate and scale of change in our society. Technology, of course, can be identified as a driving factor and has radically transformed every aspect of our children’s lives. The internet, social media, and mobile phones have brought a number of benefits as well as challenges to the lives of our youth and the families that strive to strike a balance with this double-edged sword. Parents in the digital age have had to educate themselves and develop new strategies for parenting to leverage the positives over the negatives.

Like the rise of the digital age, the Children’s Mental Health System is undergoing a major transformation in the form of Children’s Medicaid Redesign that will significantly redefine many aspects of the current system of care. As a parallel process to the parents we serve, providers in today’s system will have to educate themselves around these changes as well as develop new strategies for service delivery to leverage the benefits over the challenges.

Sweeping Changes Focus on Quality of Care

The sweeping change that the Children’s Mental Health System is currently experiencing consists of several major initiatives: Health Homes, Children and Family Treatments and Supports (CFTS), an expanded array of Home and Community Based Services (HCBS), the transition of behavioral health benefits into managed care, and a shift in focus to quality of care (value-based payments).

The Health Home model, which was launched in the children’s system of care in December of 2016, aims to provide care coordination services. CFTS and HCBS will establish an array of individualized services (as opposed to a program with multiple components) that can be wrapped around youth and their families to help facilitate and support progress towards meeting goals. Services in the CFTS array include Other Licensed Provider, Psychosocial Rehabilitation and Community Psychiatric Supports and Treatments which are expected to begin on January 1, 2019; Family Peer Support Services are targeted for July 1, 2019; and Youth Peer Support Services and Crisis Intervention are due to launch on January 1, 2020. The expanded HCBS array of services will include services such as Respite (planned and crisis), Prevocational Services, Supported Employment, Caregiver/Family Supports and Services, Community Advocacy Training and Support and will begin on January 1, 2019. The transition of behavioral health benefits to managed care occurred on July 1, 2018 while the focus on value- based payments is slated to be addressed after the majority of the transition has occurred.

Prevention and Early Intervention Reflect the New Standards in Excellence

These changes have begun and will continue to redefine service delivery within the Children’s Mental Health System marking a dramatic shift from comprehensive, unified programs to coordinated, individualized services. The intention behind this shift is to focus on prevention, early intervention and flexibility, giving providers the ability to identify the needs and challenges of youth and their families earlier, wrap services that match those needs around youth and families timelier, in addition to giving providers more opportunities to engage youth and families in settings that work best for them (i.e. their home communities). In capturing the intention behind the transformation, the phrase, “the right services, at the right time, in the right amount,” was often referenced. The idea is simple – provide a service which matches the needs of the youth and family, at the time that need is identified, for the amount of time that is necessary to address the need, and we can hopefully help youth and their families be more successful at reaching their goals and preventing reliance on more intense, longer term services.

By understanding the intentions behind the changes, it is easy to begin to pinpoint some of the benefits this new system of service delivery hopes to achieve such as quick, early access to the least restrictive services necessary to achieve the desired outcomes. Additionally, these changes hope to usher in benefits beyond those that are readily apparent such as expanding services, expanding eligibility for these services, increasing engagement by meeting youth and families where they are at (both in regard to their physical location as well as their strengths and needs at a given point) and focus on quality of care over quantity.

Re-Education Challenges Facing Parents and Network Providers

While it is easy to focus on the benefits this change will bring to the system of care, providers must not lose sight of the challenges the system will face. Much like parents today developing new ways to prevent their youth’s access to inappropriate content on the internet or protect their youth from cyberbullying, the Children’s Mental Health System on a whole will need to develop new strategies, workflows, policies, and procedures to ensure these challenges are overcome. While the full extent of challenges (and benefits for that matter) are yet to be seen, some have already become apparent, such as the significant need for education and training to all stakeholders within the system regarding the changes and their role in the delivery of these new services, a greater reliance on the coordination of multiple providers providing multiple services as we move away from unified programs, and the need for increased networking and partnerships amongst providers in the system of care.

To take a lesson from the radical shift in life brought on by the digital age, despite the challenges we face as a society as technology, the internet, mobile phones, and social media dramatically reshape the ways in which we operate, the prevalence and continued integration of technology into our lives seems to indicate that the benefits far outweigh the challenges. The increased ability through technology to access information and services that enhance our lives and allow us to stay connected with our friends and families around the world is seemingly worth the effort needed to put new systems in place to mitigate the challenges this connectivity brings to our world. Similarly, if the Children’s Medicaid Redesign efforts can increase youth and their families’ access and connectivity to the behavioral health services and supports that help them meet their goals and thus their full potential, then it is well worth the effort of the system of care to embrace these changes.

With this in mind, the WellLife Network is committed to developing and expanding services within the Children’s Mental Health System to increase access to youth and families across Long Island and New York City. The WellLife Network has been designated to provide numerous services within the CFTS and HCBS array of services and plans to expand its Children’s Health Home program. Join us as we embrace this change and work to transform the system to better serve our communities.

“Change can be frightening, and the temptation is often to resist it. But change almost always provides opportunities – to learn new things, to rethink tired processes, and to improve the way we work.”

– Klaus Schwab

For more information about WellLife Network’s Child and Community Based programs, call (631) 920-8302.

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