Administration of Mental Health Services by Medicaid Agencies

The Medicaid director in one State underscoredthe importance of working on commonproblems by contrasting the State’s differingexperiences with child and adultmental health services. In this State, Medicaidfunds services for almost all beneficiaries ofthe children’s mental health agency. Becausethe State Medicaid agency regularly dealswith the child mental health agency on manyongoing operational issues, these agencieshave a very strong relationship. As the Medicaiddirector put it, “We’re about as close asyou can be without becoming the same agency.”By contrast, the relationships betweenthe Medicaid agency and the adult mentalhealth agency are much more distant andwary, since Medicaid funds services for only30 to 40 percent of the adult mental healthagency’s clients, and the adult service providersand advocacy groups tend to be somewhatsuspicious of Medicaid.B. Some Patterns and CorrelationsNot surprisingly, States reporting that theirMedicaid and mental health agencies frequentlycollaborate on external projects alsoare more likely to hold regularly scheduledmeetings, while States reporting less collaborationare more likely to hold meetings “asneeded.” More than half (54 percent) of allStates where the agencies collaborate frequentlyhold weekly or biweekly meetingsbetween staff at the agencies, while fewerthan 13 percent of all States where agenciescollaborate somewhat frequently or occasionallyhold meetings that often. One-third ofthe States where collaboration is somewhatfrequent or occasional report that the agencieshold meetings only “as needed,” whileonly 19 percent of States that report frequentcollaboration say they meet only as needed.States where the Medicaid and mentalhealth agencies frequently collaborate onexternal projects also are more likely toreport that the Medicaid agency is representedon the MHPC (88 vs. 75 percent), participatesin the development of the State MentalHealth Plan (81 vs. 63 percent), and has astaff member as the point person on mentalhealth issues (85 vs. 58 percent). These Statesalso are more likely to report that the Medicaidagency reserves a slot for a mental healthrepresentative on the State MCAC (69 vs. 58percent).1. Impact of Agency Structure onCollaborationThe structure of the Medicaid and mentalhealth agencies within the State governmentcorrelates with the amount of reported internaland external collaboration (Figure 3).States where the Medicaid and mental healthagencies are within the same umbrella agencyare more likely to report frequent collaboration(57 vs. 43 percent), have directors whomeet regularly (79 vs. 52 percent), have meetingsbetween the agencies at least monthly(64 vs. 43 percent), and report Medicaid participationin the development of the StateMental Health Plan (82 vs. 57 percent).These States are only half as likely to reporthaving an interagency agreement or memorandumof understanding, perhaps becausesuch formal documents are less necessarywhen there is a common umbrella agency.The structure of the agencies within theState government does not correlate withwhether a slot is reserved for a mental healthrepresentative on the State MCAC. However,States where Medicaid and mental health areseparate agencies were somewhat more likelyto have a staff member serving as the pointperson on mental health issues within theMedicaid agency (78 vs. 68 percent) and to42 Administration of Mental Health Services by Medicaid Agencies