Evaluating the District of Columbia’s Behavioral Health Transformation Medicaid 1115 Demonstration
Half of the people who experience a mental illness will also experience a substance use disorder (SUD) at some point in their lives and vice versa. The District of Columbia Department of Health Care Finance five-year Medicaid Behavioral Health Transformation Demonstration aims to strengthen the continuum of care and move Medicaid toward a more integrated model of behavioral health care delivery by expanding treatment options for SUD, serious mental illness (SMI) in adults, and serious emotional disturbance (SED) in children. In 2019 nearly 44 percent of the District’s 72,959 Medicaid fee-for-service beneficiaries had a behavioral health diagnosis, and an estimated 32 percent had an SMI/SED or SUD diagnosis. AIR is conducting a multi-site, mixed-methods evaluation of the Demonstration to identify effective interventions that increase access to and treatment of people experiencing both SUD and serious mental illness.
AIR’s evaluation assesses the Demonstration’s effectiveness in expanding and integrating SUD and SMI/SED treatment for Medicaid beneficiaries through prevention, increased access to crisis and critical levels of care, wraparound supports and care coordination. The evaluation also estimates the Demonstration’s impact on improving health outcomes, such as reduced hospital admissions, emergency department visits and overdose deaths. The evaluation will include a cost analysis examining Medicaid program costs for beneficiaries with SMI/SED and SUD, the factors driving these costs and how this may evolve over the course of the Demonstration. AIR analyzes Medicaid claims data and primary data collected through a beneficiary survey, key informant interviews and site visits for the evaluation. L&M Policy Research supports AIR in in this effort.