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County addiction, mental health board takes precautionary measures amid state budget talks

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MEDINA — As Ohio considers postponing a Medicaid initiative, the Medina County Alcohol, Drug Addiction and Mental Health Board is preparing for the possible delay in reimbursement from the state for fiscal year 2018.

At a special meeting earlier this week, the board approved setting aside funds totaling $7,643 for Catholic Charities and $212,473 for Alternative Paths Inc. The ADAMH board provides alcohol, drug addiction and mental health services through partnerships with those organizations.

Titterington-Phillip-jpg

Phillip Titterington

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“It doesn’t necessarily mean they need to spend it or they’re going to spend it, but in case, if it needs to (be spent), it’s been approved (by the board),” said Executive Director Phillip Titterington.

Medicaid redesign

He said Ohio is considering a six-month delay of Behavioral Health Redesign, an initiative that is part of Gov. John Kasich’s effort to modernize Medicaid, which could affect the agency’s and other organizations’ cash flow.

He said Ohio House’s revision of the 2018 fiscal year budget, which begins July 1, included delaying the initiative’s implementation until January.

The state will administer a series of tests for its billing agencies in the Medicaid redesign, Titterington said.

“The fear is that payments are going to get delayed, and the agencies that we work with have a minimal budget. And payment delays of two to three months will affect their cash flow and their ability to provide services,” Titterington said. “We have to be prepared if there are any issues.”

He said as of now, there has been no discussion whether services will be cut. Titterington said the board’s action was an attempt to plan ahead.

“It might take a year to assess how these changes could affect the system, but we’re trying to feel our way through now as to how to best make sure that services are still there,” Titterington said.

“If there are any gaps in services, there will be funds to allocate.”

Picking up the bill

Depending on whether Medicaid redesign is delayed, Titterington said, the board might implement a temporary “fee for service” procedure. In that setup, an agency would provide a service to a client, submit its fee to insurance companies and the remainder would be picked up by the ADAMH board.

“One of the thoughts was we could reimburse somewhat on a ‘grant model’ and the agency would get a portion of the bill as these things were getting worked out … then get on a reconciliation period, where after so many months, we’d look at the actual service they produced and modify the payment accordingly to make sure we’re paying for the services appropriately,” he said.

The budget is now in the hands of the Senate and is expected to be sent to Gov. John Kasich before the approval deadline of July 1.

“There are some uncertainties there,” Titterington said. “We’re not sure where that’s going to go.”

Obamacare repeal

Titterington explained that repeal and replacement of the federal Affordable Care Act could affect clients and service providers.

“As it’s going right now, if the Affordable Care Act is repealed, changed or modified, it will change Medicaid expansion and generally it’s not going to be in a good way,” Titterington said. “We don’t know specifically what the impact is, but we do understand that eligibility for people to get Medicaid is going to change and ultimately it will be on the board (to pick up fees for the services).”

“With our budget, we’re trying to do as much as we can,” Titterington said. “If Medicaid changes, that’s going to have to come off on us, and we’ll see that impact pretty largely.”

Still reeling from $1.2M cut

ADAMH and its partners, which also includes Solutions Behavioral Healthcare, served nearly 20,000 patients in fiscal year 2016.

Titterington said Solutions Behavioral is in a “rebuilding phase” and “is not in the position to take on additional funding like its other partners for services at this time.

The ADAMH board operates on a budget of about $4 million. Titterington said Medina County commissioners grant about $192,000 to the agency and remaining funds come from federal and state sources.

Titterington said the agency is trying to re-establish some of its services and bounce back from 2009 when its state and federal funding got cut $1.2 million.

“We’re doing our due diligence,” Titterington said. “We’re just not sure how much farther. There are a lot of unknowns.”

For more information about the ADAMH board and its services, visit www.medinamentalhealth.com.

Contact reporter Halee Heironimus at (330) 721-4012 or hheironimus@medina-gazette.com.

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