RD269 - Report on Community Services Board (CSB) Funding and Medicaid Expansion – May 15, 2020

Executive Summary:

The 2019 Appropriations Act requires The Department of Behavioral Health and Developmental Services (DBHDS) to provide a report to the Governor and General Assembly on the status of Community Services Board (CSB) general fund reductions resulting from anticipated new revenue generated from Medicaid Expansion. DBHDS convened a workgroup in Spring 2019 comprised of CSB financial officers to determine the best method for compiling information in a uniform fashion from the CSBs on a monthly basis. This workgroup developed a standard template which captures individuals served by the CSBs receiving Medicaid Expansion into three client types:

1. Individuals previously served on Governor’s Access Program
2. Individuals uninsured previously served by a CSB
3. Individuals new to the CSB system

These client types were used to comply with the reporting requirements and provide the level of detail necessary to identify general fund resources within the CSB budget that was offset by additional new revenues from Medicaid expansion.

Using the current data to make projections about a full year is a difficult process for the following reasons:

• There is still a large difference between billings and collections due to a number of factors including the transition to Medicaid managed care and other factors.
• This data was for the first six months of FY 2020, which is prior to COVID-19, which had a profound effect on all service delivery providers.
• The services provided and billing for services may not be uniform throughout the year.
• These calculations are based on CSB-provided data.

The report provides additional details and the status of the required General Fund Reduction information by CSB.

This is the final report on the impact of Medicaid expansion on CSB revenues. It should be noted that DBHDS ceased the collection of Community Service Board data related to this activity in 2020, due to the significant impacts of COVID-19 on the Medicaid service delivery as well as the burden of such activity during the response to the pandemic. The resulting disruption made it difficult to discern any trends in 2020 data beyond those reflected in subsequent reports (and as presented in this one). DBHDS does, however, continue to monitor CSB Medicaid services and the associated revenues on total service delivery level (without measuring the impact of Medicaid expansion). Additionally, while there is anecdotal evidence that some CSBs did make adjustments to their service lines as a result of the GF reductions, there is no evidence that this was due to a lack of revenue generation to make up any identified revenue shortfall experienced by a board in total.