Medicaid waiver provides key tool to redesign state’s behavioral health system

Why does Alaska need an 1115 Waiver?

  • By Adam Crum and Albert Wall
  • Saturday, August 17, 2019 10:23pm
  • Opinion

After several years of development and negotiation, the Alaska Department of Health and Social Services is rolling out a comprehensive solution to address the problems of mental health and addiction and substance misuse problems in Alaska. The vision of providing Alaskans with a comprehensive suite of cost-effective, high-quality behavioral health services will be realized through the Behavioral Health 1115 Waiver Demonstration Project. The 1115 Waiver will ensure access to the right services, at the right time, in the right setting.

Section 1115 Medicaid Demonstration Project waivers allow states to waive standard Medicaid methods to instead use innovative and customized strategies to better meet the needs of their particular state.

Why does Alaska need an 1115 Waiver? One way to picture this redesign is by imagining a home which was built many generations ago. As the family grows and changes, additions are built and old rooms repurposed as new needs arise — some unexpected and difficult to accommodate. Over time, the layout becomes awkward and cumbersome. Eventually, it makes more sense to use resources to thoughtfully design a new building rather than continually play “catch-up” with expensive renovations.

Similarly, Alaska’s current system for addressing the substance abuse and psychiatric care crisis has not been able to fully meet the challenges presented. There are currently not enough community psychiatric beds and residential substance use disorder treatment programs in Alaska. This puts a heavy burden on hospitals in urban areas and limits the options available to Alaskans who are seeking much-needed behavioral health services in their communities.

Opportunities to provide supports earlier in the lives of at-risk children and adults are often missed due to a lack of robust local or regional behavioral health services. Many Alaskans are not able to get the appropriate level of behavioral health treatment until their need reaches the crisis stage. Additionally, this waiver is designed to provide support services to help people live stable lives and meet basic needs such as supported housing and employment to assist them in accessing and staying in housing.

The 1115 Waiver will establish a network of services at the community and regional level to reduce the need for high-cost, crisis-driven and urban-based emergency, acute, and residential care. By having an 1115 waiver in place, Alaska can offer more and different choices that will generate not only greater cost savings, but also provide more options that will aid Alaskans battling addiction. It will also decrease the burden on psychiatric hospitals and emergency departments in the state, including the Alaska Psychiatric Institute.

These changes will go a long way towards rebalancing Alaska’s behavioral health system and providing a full continuum of care for individuals with substance use disorders and mental illnesses, including those experiencing homelessness. This will be accomplished through greater access to community-based treatment options and local resources that help support recovery, health and wellness.

Alaska will finally have a system custom-tailored to its unique strengths and challenges. And the 1115 Waiver is a key part of the long-term solution for changing the health care system in Alaska and providing safe communities to our fellow Alaskans.

Adam Crum, M.S.P.H., is commissioner of the Alaska Department of Health and Social Services.

Albert Wall is deputy commissioner of Family, Community & Integrated Services at the Alaska Department of Health and Social Services.


Adam Crum, M.S.P.H., is commissioner of the Alaska Department of Health and Social Services. Albert Wall is deputy commissioner of Family, Community & Integrated Services at the Alaska Department of Health and Social Services.


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