CO Medicaid & Homeless Coloradans w/ Mental Illness

Issues of Harm Reduction, Level of Care, Choice and Economics

THE ISSUE

• Some Coloradans with Mental Illness who are HOMELESS meet the criteria for CO MEDICAID Long Term Care
• BUT they don't need assistance with activities of daily living.   This requirement for the CMHS (Community Mental Health Supports) Waiver was put in rule at 8.509.15.A.2

There has been a lot of PLAYING GAMES in Colorado Medicaid Mental Health because it is SO POLITICAL, SO EXPENSIVE & the NEED IS SO GREAT..

There are a lot of moving parts --- BUT this doesn't look like PARITY to us.

We would like to see a STATE STAKEHOLDER GROUP that specifically addressed the needs of Coloradans with Mental Illness who meet the LEVEL OF CARE for Medicaid Long Term Care BUT don't need help with activities of daily living.

• With special attention to Coloradans who are Homeless and or being released from Jail or Prison.

Further

• Medicaid Long Term Care generally opens up the possibility of:
  • Nursing Home Care
  • Assisted Living Care
  • In Home Care
    

Medicaid Home & Community Based Services "Waivers" such as the Colorado Community Mental Health Supports (CMHS) Waiver are designed for people who meet the level of care for a "nursing home" but can be served in the community.

There are many younger people with mental illness in Nursing Homes because there are insufficient services in the Community -- both on locked wards and open wards.

There are even more younger people with mental illness who are homeless and/or incarcerated because there are insufficient services in the Community.

What a Tangled Web We Weave --- What Was Really Going On In HCPF's Change of Targeting Criteria

CO's Mental Health Continuum of Care Hell

Fixing HCPF's Fair Housing Problem

Nursing Homes & Housing

8.509.15 ELIGIBLE PERSONS

A. HCBS-CMHS services shall be offered to persons who meet all of the eligibility requirements
below:  . . .

2. Level of Care AND Target Group.
Clients who have been determined to meet the level of care AND target group criteria
shall be certified by the Utilization Review Contractor (URC) as functionally eligible for
HCBS-CMHS. The URC shall only certify HCBS-CMHS eligibility for those Clients:
a. Determined to meet the target group definition, defined as a person experiencing
a severe and persistent mental health need that requires assistance with one or
more Activities of Daily Living (ADL);

i. A person experiencing a severe and persistent mental health need is
defined as someone who:

1) Is 18 years of age or older with a severe and persistent mental
health need; and

2) Currently has or at any time during the past year leading up to
assessment has a diagnosable mental, behavioral, or emotional
disorder of sufficient duration to meet diagnostic criteria specified
within the Diagnostic and Statistical Manual of Mental Disorders
(DSM -5); and
a) Has a disorder that is episodic, recurrent, or has
persistent features, but may vary in terms of severity and
disabling effects; and
b) Has resulted in functional impairment which substantially
interferes with or limits one or more major life activities.

ii. A severe and persistent mental health need does not include:
1) Intellectual or developmental disorders; or
2) Substance use disorder without a co-occurring diagnosis of a
severe and persistent mental health need.

b. Determined by a formal level of care assessment to require the level of care
available in a nursing facility, according to Section 8.401.11-15; and

c. A length of stay shall be assigned by the URC for approved admissions,
according to guidelines at Section 8.402.50.