Administration of Mental Health Services by Medicaid Agencies

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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
Administration of Mental Health Services by Medicaid Agencies 43
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 and 16: I. IntroductionState Medicaid agenc
Page 17 and 18: with Medicaid playing a more promin
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 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
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