From coast to coast, the workforce shortage is hurting behavioral health providers, leaving many stumped as to how to fix the problem, which has been affecting access to care and providers’ business operations for years.
But industry leaders and advocates in Illinois have a plan: They’re hoping for the development of a unique state-wide workforce development program while also leaning into innovative models of care such as integrated health homes and keeping their eyes on the certified community behavioral health clinic (CCBHCs) demonstration program, which Illinois is not yet a part of.
The game plan to tackle the workforce shortage was just one of many takeaways from Community Behavioral Healthcare Association (CBHA) of Illinois’s 47th Annual Conference, which kicked off Monday in Schaumburg, Illinois.
BHB sat down with CBHA CEO Marvin Lindsey at the event to discuss that game plan in more depth, among other issues.
You can find that conversation below, edited for length and clarity.
BHB: Can you start by telling me a little bit about your organization and its membership? For example, how many members do you have and what kind of organizations are part of CBHA?
Lindsey: We’re a trade association of mental health and substance abuse providers. We have about 90 members all around the state.
They provide mental health services and substance abuse services to families, adults, children and adolescents.
Would it be accurate to say that all of those providers are mostly reimbursed by Medicaid?
We have done a survey that shows across the board our members provide about 70% Medicaid services on average.
We have some that provide 100% Medicaid, and some that might provide 50%.
We also provide services to the working poor, so those people who are a little above Medicaid but just don’t have the money to get insurance. They might enter into our system on a sliding fee scale.
Illinois is a Medicaid expansion state. How has that changed things, if at all, for the working poor you just mentioned and the providers that care for them?
It has changed a great deal. Now we’re able to serve that population between 18 and 64 who were not traditionally able to get Medicaid.
We did see a good deal of new clients and patients coming into the mental health and substance use system after Medicaid expanded.
Medicaid is so important to our system — especially with all the things going on in our system.
That gets back to our conference theme of connecting the dots. There are so many providers here that are connecting those dots, whether it’s treatment, whether it’s new types of service models or a variety of other things.
Connecting those dots isn’t always easy to do. What are the biggest challenges CBHA organizations are facing right now?
Workforce is number one, closely followed by inadequate rates. There’s just such a disparity in Medicaid rates.
Providers have been able to do what they can, but they’re doing it at the expense of access and a workforce.
In southern Illinois, for example, one provider is losing staff to the local Aldi, because the its able to pay $15 an hour compared to their $11 an hour for BA-level staff.
What’s going to have to happen to fix those workforce issues?
We wrote a bill last year that called for a behavioral health workforce development task force. The last meeting of that task force is this week.
That task force will be coming out with a report at the end of this month. It will show the behavioral health workforce issues in Illinois and be asking for the development of a behavioral health workforce development center housed at one of the state universities.
We think that’s going to be the beginning of us being able to build a pipeline and focus on retention and recruitment of new people into our field.
There’s been one other center, and that was in Nebraska. We’re trying to model it after Nebraska, which saw a 15% increase in their care workforce [between 2010 and 2016, following the creation of its center, the Behavioral Health Education Center of Nebraska, in 2009].
Staying on that positive note, what are the biggest opportunities for behavioral health providers right now?
The biggest opportunities are the different models, like the integrated health homes, which allow providers to take a shot at care coordination.
There’s also the Illinois Health Practice Alliance, [which is a clinically-integrated behavioral health network]. That is a very new, innovative model that is the first of its kind in the country. It’s brought together providers and managed care in a way that’s never happened in Illinois or anywhere else that we’ve heard of.
One innovative model that’s been getting a lot of attention nationwide recently is CCBHCs. Illinois isn’t part of the demonstration, but what are your thoughts on that program’s potential?
We do have one provider that’s doing a project with a planning grant, but you’re right, Illinois was not one of the CCBHC demonstration states.
But the [Senate Finance Committee] is pushing for 11 new states to be included. We’ll definitely be talking to our state Medicaid directors here to try to get them involved in that.
Another hot topic is the recent expansion of Medicare coverage for more substance abuse services. How will that affect your providers?
I think it will be good for our providers because a good number of them provide coverage or services to dual eligible beneficiaries, who have both Medicaid and Medicare.
Now they’ll be able to bill through Medicare for substance use services. Some of our member do provide Medicare alone, so that will help them, too.
There’s a substance abuse problem within the elderly that really goes unrecognized, so our members will be able to get into that arena and provide services.
Any extra money has to be helpful.
It is, and Medicare pays higher rates than Medicaid.
Another thing is that the state is bringing Medicaid psychiatric rates up to Medicare rates. That’s also great news because before you had psychiatrists being contracted with community providers at half of their cost.
It’s ridiculously low, so to hear that that rate is going to increase is very good news.