Administration of Mental Health Services by Medicaid Agencies

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■■■Organizational Structure. In most States,the Medicaid director reports directly tothe Governor or is separated by only onereporting level. State Medicaid and mentalhealth agencies are within the sameumbrella agency in 28 States, most commonlyhealth and human services, and areseparate in 23 States.Funding. In 26 States, the State match forMedicaid mental health services comes atleast partially from a different source thanthe State general fund, most frequentlyfrom counties or other local sources. In32 States, the State match comes at leastpartially from the mental health agency.Providers. The majority of States restrictMedicaid providers of mental health servicesto those with a mental health designation,and 22 States delegate the enrollmentof mental health providers to themental health agency. Twenty-six Statesreported that at least some Medicaidmental health services or populations arecovered through behavioral health organizationsor administrative servicesorganizations.■to the legislature. Medicaid and mentalhealth agency collaboration tends to behighest in States where both agencies arein the same umbrella agency and lowestwhere they are in separate agencies andwhere the mental health agency hasauthority to set some Medicaid rates.Authority. Medicaid agency authority overmental health funding, provider rate setting,and data appears to be highest whenMedicaid and mental health agencies operateseparately and there are limited opportunitiesfor Medicaid to make use of thepublic mental health system, while Medicaidagency authority tends to be lowerwhen the agencies are part of the sameumbrella agency and the public mentalhealth system has the capacity to administerMedicaid services.■■Data and Reporting. Forty States reportedthat their Medicaid agencies produce formalreports containing discrete data onMedicaid mental health utilization orexpenditures, and in 27 States the mentalhealth agency produces such reports. MostStates allow the mental health agencyaccess to the Medicaid Management InformationSystem (MMIS), but very fewStates have linked client-level data.Collaboration. Slightly more than half theMedicaid respondents said that Medicaidand mental health agencies collaborate frequentlythrough internal and externalmeetings, public reports, or presentationsxii Administration of Mental Health Services by Medicaid Agencies
I. IntroductionState Medicaid agencies are playing an increasingly important rolein the funding and administration of State mental health services.While the increase in Medicaid funding for mental health servicesin recent decades and the major factors that account for it have been welldescribed, less is known about how State Medicaid agencies are exercisingtheir growing responsibilities for mental health services. Accordingly,the Federal Substance Abuse and Mental Health Services Administration(SAMHSA) commissioned a telephone survey of State Medicaid agenciesaimed at learning more about how these agencies administer Medicaid-fundedmental health services. The survey asked questions about how Medicaidagencies are organized, what their relationships are with State mental healthagencies, and how funding, provider, data, and reporting issues are handled.The results of the survey are summarized in this report.A. Background and ContextIn 2001, Medicaid spending for mentalhealth care accounted for 27 percent of totalmental health expenditures by all public andprivate payers combined, up from 19 percentin 1991 and 14 percent in 1971. Other Stateand local spending on mental health (includingthat provided through mental healthagencies) dropped from 30 percent in 1971to 27 percent in 1991 and 23 percent in2001 (Mark et al., 2005). Medicaid nowfunds more than half of all mental healthservices administered by States, and couldaccount for two-thirds of such spending by2017 (Buck, 2003). Between 8 and 12 percentof all Medicaid dollars are spent onmental health services (Mark, Buck, Dilonardo,Coffey, & Chalk, 2003).The trend toward greater Medicaid fundingof mental health services began soonafter the Medicaid program was enacted in1965, as mental health care shifted frominstitutional to community settings, and asMedicaid began taking over more of thefinancing role held by State or county mentalhealth authorities before 1970. Between1970 and 1980, the number of inpatient psychiatricbeds in State and county hospitalsfell by more than half as cases and costswere shifted to Medicaid-reimbursable settingsin the community (Frank & Glied,2006a, 2006b).Increased Medicaid funding of mentalhealth services has substantially changed theState mental health policy landscape. FederalMedicaid requirements have reduced theflexibility States previously had to shapemental health services and their delivery, andpressures to use State mental health dollarsto obtain additional Medicaid funding havesometimes limited the ability of mentalhealth agencies to provide services for thosenot eligible for Medicaid (Frank, Goldman& Hogan, 2003).Administration of Mental Health Services by Medicaid Agencies 1
Page 1: Administrationof MentalHealthServic
Page 5 and 6: AcknowledgmentsThis report was prep
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Page 10 and 11: Tables12345678Organizational Struct
Page 13: Executive SummaryState Medicaid age
Page 17 and 18: with Medicaid playing a more promin
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Page 22 and 23: “Single State Agency” Requireme
Page 24 and 25: Table 1: Organizational StructureSt
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Page 45 and 46: The other agency that most commonly
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Page 50 and 51: Table 7: CollaborationMental Health
Page 52 and 53: Table 7: Collaboration, continuedMe
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■- The Medicaid agency participat
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programs and are provided in either
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4.2 million for all States, and thr
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V. Summary and ConclusionsThe surve
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less frequent but still regularly s
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specific nature of these State-loca
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Appendix AAdditional State-by-State
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Table A.1: Medicaid Mental Health S
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Table A.2: Services Defined as Medi
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Table A.2: Services Defined as Medi
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Table A.3: Managed Care, continuedS
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Table A.4: Data, continuedState MMI
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MPR Staff:■■■■■■■Lori
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