Community Health Choice Testimony to House Select Mental Health Committee

1. Community Health Choice Testimony to House Select Mental Health Committee Ken Janda President and CEO June 2, 2016

2. Organizational Basics • Not-for-profit corporation (501(c)4) created by Harris County Hospital District. • Licensed by TDI as HMO (and third party administrator). • Operates in 20 counties in Southeast Texas (headquartered in Houston). • Safety Net Health Plan, as defined by ACA. Serves over 370,000 Members with the following programs: • Medicaid State of Texas Access Reform (STAR) Program for low-income children and pregnant women (1997). • Children’s Health Insurance Program (CHIP) for the children of low-income parents (2006), which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR (2007). • Health Insurance Marketplace Plans offered in the ACA’s Federally Facilitated Marketplace, for individuals, including plans with subsidized premiums for lower income families (2014). • Regional HMO coverage for State of Texas employees (ERS) (2015). • Administrator for multiple collaborative safety net projects including TexHealth 3-Share insurance subsidies (2008), DSRIP (2013), and NAIP (2015).

3. Mental Health Services and Challenges • Strong support for mental health parity in benefits and operations. • Collaborate with Beacon Health Options for behavioral health network and care management systems. • Robust networkof professionals and facilities, including strong relationships with local mental health authorities, federally qualified health centers, and other safety-net and private providers. • Clinical and care management programs coordinated between mental health and physical health conditions. • Challenges: • Lack of psychiatrists, especially in rural areas. • Eligibility challenges, e.g. women 60 days after delivery (post-partum depression), adults unable to be certified for SSI, etc. • Creation of value based payment system integrating behavioral and physical health. • Lack of sustainable funding source for DSRIP projects involving mental health for those currently uninsured.

4. Recommendation: Coverage Coverage expansion under renewal of 1115 waiver: • Disproportionate number of people with mental health conditions are low-income and uninsured (difficult to maintain employment). • Increase number of mental health providers. Direct correlation between high levels of uninsured and fewer providers per capita. (Pay them and they will come). • Care coordination and integration is much better in a managed care system. Current fragmented system is inefficient and difficult to navigate. • Managed care plans can create and pay for non-traditional home and community services. In states with coverage expansion, MCO coordination with homeless programs, jail diversion programs, and other services has made significant improvements in access and outcomeswhile reducing costs. • Additional federal funds would allow reduction in state and local funding, and still increase overall funding.