Administration of Mental Health Services by Medicaid Agencies

More documents

Recommendations

Info

1. Shift from Institutional toCommunity ServicesAs noted above, a major reason for the shifttoward Medicaid funding of mental healthservices is the trend during the past quarterof a century away from providing mentalhealth services in institutions, where Medicaidfunding is very limited, toward providingservices in the community, where Medicaidfunding is more readily available. This movementto deinstitutionalize mental health servicesis consistent with Federal policy on thedelivery of care to persons with mental illness.The President’s New Freedom Commissionon Mental Health identified deliveringcare in an integrated setting, with “services incommunities rather than institutions,” as oneof the hallmarks of a “transformed system”for treating mental illness. “[T]he Nationmust replace unnecessary institutional carewith efficient, effective community servicesthat people can count on,” the Commissionsaid. “It needs to integrate programs thatare fragmented across levels of governmentand among many agencies” (New FreedomCommission on Mental Health, 2003,pp. 3–4).2. Impact on FinancingWhite and Draper (2004) identify this shifttoward community care as sparking the trendtoward increased Medicaid funding for mentalhealth services. Since Federal Medicaidregulations prohibit funding services foradults between 22 and 64 years of age ininstitutions for mental diseases (the IMDexclusion), deinstitutionalization has resultedin many previously ineligible persons becomingeligible to receive Medicaid-funded services.Many States, facing budget shortfalls,looked to Medicaid as a way to save moneyby obtaining a Federal match for services thatformerly had been covered solely by the Stategeneral fund. Between 1997 and 2001, Statematch and Federal Medicaid funds for mentalhealth services increased 69 percent, whileState general funds rose by only 19 percent(National Association of State Mental HealthProgram Directors Research Institute [NRI],2004). The influx of Medicaid funding hasgiven State and Federal Medicaid agenciesmore overall influence within State publicmental health systems (Frank et al., 2003).There has, however, been no systematic Stateby-Stateanalysis of the characteristics of thisinfluence, from the Medicaid agency perspective,with respect to the policy-setting process,funding arrangements, or data sharing.(As noted below, several surveys in recentyears have looked at these issues from theperspective of State mental health agencies.)3. Impact on Organizational StructureThe increasing role of Medicaid in providingmental health services also may influence thestructure of State agencies, and it may affectany reorganizations States undertake. In2003, a study of State restructuring effortsfound that 18 of the 22 States undergoingchanges were consolidating health (and sometimeshuman services) agencies, in many casesunder one umbrella agency (VanLandeghem,2004). The rationale for many of theserestructurings was to move away from definingState agencies by services and towarddefining them by the populations they served.Of the 15 State restructuring initiatives thataffected Medicaid in 2003, 4 States proposedelevating the Medicaid agency to a moreprominent place within existing health structures(VanLandeghem, 2004). 1 The movetoward more consolidated health structures,1The report did not say whether any of thereorganizations proposed elevating mentalhealth agencies.2Administration of Mental Health Services by Medicaid Agencies
with Medicaid playing a more prominentrole, is consistent with the enhanced roleMedicaid has played in funding mental healthservices. In 2003, 21 States reported havingan umbrella agency that included both Medicaidand the mental health authority, while15 States had independent mental healthagencies (VanLandeghem, 2004). To theextent that the trend toward mental healthservices being funded by Medicaid continues,restructurings may result in more mentalhealth authorities being co-located along withMedicaid within larger health structures.4. Impact on ConsumersThe 2003 New Freedom Commission reportnoted that the complex mental health systemoverwhelms many consumers and that “fragmentationis a serious problem at the Statelevel”:State mental health authorities haveenormous responsibility to delivermental health care and support services,yet they have limited influenceover many of the programs consumersand families need. Most resources forpeople with serious mental illness (e.g.,Medicaid) are not typically within thedirect control or accountability of theadministrator of the State mental healthsystem. For example, depending on theState and how the budget is prepared,Medicaid may be administered by aseparate agency with limited mentalhealth expertise. Separate entities alsoadminister criminal justice, housing,and education programs, contributingto fragmented services (New FreedomCommission, 2003, p. 3).B. Survey of State MedicaidDirectorsThis report provides, from the perspective ofState Medicaid agencies, a State-by-State lookat some of the effects of increased Medicaidfunding and influence on the provision ofmental health services. It is based on theresults of a telephone survey of Medicaiddirectors or their designees in all 50 Statesand the District of Columbia.1. MethodologyThe telephone survey was conducted betweenJuly 2005 and February 2006. 2 This hourlong,in-depth interview, consisting of bothclosed- and open-ended questions, wasdesigned to gather the Medicaid perspectiveon five domains: organizational structure,Medicaid mental health policy infrastructure,Medicaid mental health services and spending,Medicaid mental health providers, anddata use and reporting. Given their busyschedules, those respondents who wanted tocomplete the closed-ended questions prior tothe telephone interview could request andreceive a copy of the survey instrument inadvance.The response rate was 100 percent, withfive States electing to complete the surveyentirely in writing rather than through a telephoneinterview. In 22 States, the respondentswere the heads of the Medicaid agency;in 7 States the respondents reported directlyto the Medicaid directors; in 15 States therewere one or more levels between the respondentsand the Medicaid directors; and in 6States the Medicaid directors designatedrespondents in the State mental healthagency. 3 On average, the respondents hadheld their current positions for 4 years andhad been involved in their States’ or any2Three Medicaid director interviews wereconducted in late 2004, as part of a pretestof the survey instrument.3In one State, the survey was filled out andreturned via fax without respondent identification.Administration of Mental Health Services by Medicaid Agencies 3
Page 1: Administrationof MentalHealthServic
Page 5 and 6: AcknowledgmentsThis report was prep
Page 8 and 9: III. Medicaid Agency Collaboration
Page 10 and 11: Tables12345678Organizational Struct
Page 13 and 14: Executive SummaryState Medicaid age
Page 15: I. IntroductionState Medicaid agenc
Page 19: cussions of some issues raised in r
Page 22 and 23: “Single State Agency” Requireme
Page 24 and 25: Table 1: Organizational StructureSt
Page 28 and 29: services for adults ages 22 to 64 i
Page 30 and 31: Table 2: Sources of Medicaid Fundin
Page 32 and 33: Table 2: Sources of Medicaid Fundin
Page 34 and 35: Thirty-nine States classified psych
Page 36 and 37: Table 4: Medicaid Mental Health Pro
Page 38 and 39: Table 4: Medicaid Mental Health Pro
Page 40: in providing Medicaid mental health
Page 43 and 44: Table 5: Formal Reports on Medicaid
Page 45 and 46: The other agency that most commonly
Page 47: health utilization or expenditures,
Page 50 and 51: Table 7: CollaborationMental Health
Page 52 and 53: Table 7: Collaboration, continuedMe
Page 54 and 55: 3. Director MeetingsRegularly sched
Page 56 and 57: The Medicaid director in one State
Page 58 and 59: have the Medicaid agency represente
Page 60 and 61: aid and mental health work together
Page 62 and 63: A. State ClassificationsThe State c
Page 64 and 65: ■- The Medicaid agency participat
Page 66 and 67:
programs and are provided in either
Page 68 and 69:
4.2 million for all States, and thr
Page 71 and 72:
V. Summary and ConclusionsThe surve
Page 73 and 74:
less frequent but still regularly s
Page 75:
specific nature of these State-loca
Page 79 and 80:
Appendix AAdditional State-by-State
Page 81 and 82:
Table A.1: Medicaid Mental Health S
Page 83 and 84:
Table A.2: Services Defined as Medi
Page 85 and 86:
Table A.2: Services Defined as Medi
Page 87 and 88:
Table A.3: Managed Care, continuedS
Page 89:
Table A.4: Data, continuedState MMI
Page 92:
MPR Staff:■■■■■■■Lori
show all

Administration of Mental Health Services by Medicaid Agencies

Create successful ePaper yourself

Delete template?

Save as template?