Administration of Mental Health Services by Medicaid Agencies

Table 8: Mental Health PolicyWorking GroupsTotal Working Groups 60Mental health agency 53Medicaid agency 52Children and family services 38Substance abuse agency 33Juvenile justice agency 25Social services agency 25Health department 22Education department 21Disabilities agency 21Special education 16Corrections agency 15Rehabilitation agency 13Governor’s office staff 7Budget office staff 6State legislative staff 6Other agencies 12a. Examples of What Working Groups DoA number of States have created workinggroups focused on integrating systems of carefor children who receive services from multipleState agencies, particularly those in thefoster care or juvenile justice systems. Someof these States gave the need to comply withthe Olmstead decision as the reason for creatinga work group to specifically addressmental health service coordination for children.20 In one State, the Medicaid and mental20In Olmstead v. L.C., 527 U.S. 581 (1999),the U.S. Supreme Court ruled that, under the1990 Americans with Disabilities Act, Statesare required to place persons with mentaldisabilities in community settings rather thaninstitutions when the State’s treatment professionalshave determined that communityplacement is appropriate, the transfer frominstitutional care to a less restrictive settingis not opposed by the affected individual,and the placement can reasonably be accommodated,taking into account the resourcesavailable to the State and the needs of otherswith mental disabilities.health agencies work together on severalcommon projects, including efforts to bring(or keep) home those children currently sentout of the State for services. In another State,a steering committee was created with theintent of focusing on a population ratherthan a service structure. This committee isparticularly valuable, the interviewee said,since the State’s Medicaid and mental healthagencies are no longer under the sameumbrella organization. Now, the intervieweesaid, “When there are problems, we have aforum to talk about them,” and each agencyis able to go back and implement the agreeduponsolution.Through one of its working groups, anotherState has created a protocol for childrenbeing removed from their homes. In suchcases, the mental health agency is notified 24hours prior to or within 24 hours of a childbeing removed, so that agency officials cancontact the home and the child to provideservices. This same State is working to bringmental health services into juvenile detentioncenters to serve children who may be “inlimbo” between the two systems. In yetanother State, the Medicaid and mentalhealth agencies work together through a children’spartnership to determine “how wisely[they] are spending [their State’s] mentalhealth dollars.” The partnership pulls togetherutilization data to find where money isspent and to determine whether collaborationcould reduce the duplication of services.In several States, formal or informal interagencyworking groups meet regularly to discussdifficult individual cases, often instanceswhen people fall through the cracks. Thesediscussions can lead to changes in procedures,policies, and organizational structuresto better address the larger problems highlightedby the specific cases.Administration of Mental Health Services by Medicaid Agencies 41