LACONIA — The Belknap County Commission agreed Wednesday to become an affiliate member of the Community Health Services Network LLC, the umbrella organization formed to transform the system for providing mental health and substance abuse services by integrating behavioral and physical health care.
Commissioners David DeVoy of Sanbornton and Hunter Taylor of Barnstead voted in favor of membership while Commissioner Richard Burchell of Gilmanton dissented.
The initiative is in response to the New Hampshire Health Protection Program, which by expanding eligibility for Medicaid and providing benefits for substance abuse has increased demand for services in short supply. Currently, 92 percent of adults who require treatment for alcohol abuse and 84 percent of adults who require treatment for drug abuse go without it. At the same time, two of every three people with mental illness admitted to the New Hampshire Hospital spend more than one day waiting in an emergency room until a bed becomes available.
In January, the Centers for Medicare and Medicaid Services approved the state's request to fund transforming the system for providing mental health and substance abuse services. The so-called "transformation waiver" will provide $150 million over five years to apply toward offering integrated physical and behavioral health care, expanding capacity to address emergent behavioral health issues, and ensuring an unbroken continuum of care as patients pass from one provider to another.
The principal agents of the program will be seven "integrated delivery networks," or IDNs, one of which will consist of the Central and Winnipesaukee public health networks, consisting of Belknap County, 18 towns in Grafton County and three towns in Merrimack County. Altogether, some 16,000 people in the network are enrolled in Medicaid, 12,000 of them in the Winnipesaukee network.
The IDNs will organize and coordinate the providers within the network as well as receive and distribute funding to them. The partners in the networks must include primary care physicians, substance abuse providers, hospitals, community mental health centers, community and rural health centers, community organizations providing social services and county nursing and correctional facilities.
Lisa Morris of the Lakes Region Partnership of Public Health that a major component of the program will be to improve the transition from institutional to community settings in order to reduce the number, frequency and cost of people requiring institutionalization. With respect to the county, the initiative bears directly on the Department of Corrections, where a significant share of inmates housed in the county jail suffer from mental illness or substance abuse and often both.
Jacqui Abikoff of Horizons Counseling Center in Gilford told the commissioners that for inmates leaving the jail and returning to the community, access to appropriate services is especially important to lessen the likelihood they will relapse and be returned to jail. She explained that ensuring an effective transition to an effective network of treatment and recovery services will contribute to reducing recidivism rates arising from mental health and substance use disorders.
Morris emphasized that the county would incur no financial obligation by participating in the Community Health Services Network. When Burchell suggested that the initiative represented "downshifting" of responsibilities from the federal and state governments to counties and municipalities, which would be lumbered with the costs when the initial funding is exhausted.
Taylor, who has advocated for expanding capacity for treatment and recovery acknowledged that "there is a risk the programs cannot be sustained," but said simply "we cannot afford not to take the risk." He called the initiative "long overdue" and "an admirable effort."
The Winnipesaukee Health Council has identified access to behavioral health care, including substance abuse treatment, as a high priority in the region. In January, the Community Health Services Network LLC was formed. The network includes LRGHeathcare, Speare Memorial Hospital, Genesis Behavioral Health, Horizons Counseling Center, HealthFirst, Lakes Region Partnership for Public Health, Lakes Region Community Services, Central New Hampshire Hospice and Visiting Nurse Association, Franklin Visiting Nurse Association and Community Action Program Belknap-Merrimack Counties.
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