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Jeff Lunardi Talks about the State's Policy Role in Mental Health

The Schroeder Center for Health Policy welcomed Jeff Lunardi on Tuesday, September 28 as the second of five speakers in its "State Policy on Mental Health and Substance Abuse" speaker series.  Mr. Lunardi, a W&M graduate (BA, ’05; MBA, ’07) and Executive Director of the Virginia Joint Commission on Health Care (JCHC), gave a talk entitled “Addressing Behavioral Health in Virginia: State Policy Role.”  JCHC is a standing commission of the Virginia General Assembly. Its members include ten Delegates and eight Senators who identify health policy issues that Commission staff study (health care provision, regulation, insurance, liability, licensing, and delivery of services).  JCHC staff conduct research and make recommendations for legislative actions to “ensure that the Commonwealth as provider, financier, and regulator adopts the most cost-effective and efficacious means of delivery of health care services so that the greatest number of Virginians receive quality health care.” The JCHC recommends health care policy changes not only through legislation, but through budget language and direction to agencies, focusing on four main objectives: equity, affordability, accessibility, and quality.

In an engaging hour-long discussion, Mr. Lunardi discussed the role that JCHC plays in improving and making healthcare more accessible for all Virginians and his experience working in the policy world both at JCHC and the Joint Legislative Audit and Review Commission (JLARC). Specifically, he focused on the State’s role in behavioral health policy, current behavioral health policy issues which includes both mental health and substance use disorders, and careers in state health policy.

Mr. Lunardi first outlined the State’s three primary roles (provider, payer, and regulator) in behavioral health policy. He stated that for some groups, Virginia is a direct provider of healthcare services, such as in state prisons, state mental health hospitals, community services boards, and local/regional jails.  In state prisons alone, for example, Virginia provides services to approximately 16,000-17,000 incarcerated individuals with some form of mental health or substance abuse issue.  Mr. Lunardi then explained Virginia’s role as a payer, discussing how Medicaid paid over $760 million in FY 2020 for behavioral health services and covered a continuum of community-based and inpatient behavioral health services. Currently, 1.9 million people are enrolled in Virginia’s Medicaid program, and an estimated 120,000 are receiving some behavioral health service. In addition, Mr. Lunardi explained Virginia’s role as regulator, describing how multiple state agencies regulate insurers, providers, and facilities.  These state agencies include the Bureau of Insurance, Department of Health Professions, Department of Behavioral Health and Developmental Services, Department of Health, and Department of Social Services.

Later, Mr. Lunardi moved into a discussion of current behavioral health policy issues in Virginia.   He focused first on how the COVID pandemic increased the need for behavioral health services, as many individuals with pre-existing behavioral health conditions lost both healthcare services and support systems.  In addition, Mr. Lunardi noted that many individuals faced new anxiety or depression due to isolation, financial stress, and fear for their health.

Another challenge that Mr. Lunardi highlighted was the crisis in Virginia’s mental health hospitals -- lack of beds and staffing shortages (nurses, psychiatrists, counseling professionals).  He noted that nursing shortages are due to low pay and the difficult nature of the job, both physically and mentally. In response to staffing shortages, the Virginia Medicaid program is working on redesigning behavioral health services by providing more vital community-based services to mitigate mental health crises and limit the need for hospitalization.

Finally, Mr. Lunardi encouraged William & Mary students to consider work in the healthcare field.  He mentioned the availability of policy-related jobs as well as positions in finance, operations, and management. He recommended that undergraduate and graduate students consider the Virginia Management Fellows Program, a two-year program where employees work in eight-month rotations throughout different agencies in the Virginia state government.

Please join the Schroeder Center for Health Policy when it hosts a talk by Dr. R. Lorraine Collins on  Zoom on October 26th at 5 pm. Dr. Collins, a psychologist who studies addiction and substance use, will speak about how research on the health effects of cannabis influences policy. To register for the Zoom link, please click here.