Administration of Mental Health Services by Medicaid Agencies

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have the Medicaid agency represented on theState MHPC (87 vs. 79 percent).2. Rate-Setting Authority and CollaborationStates where the mental health agency has theauthority to set rates for at least one Medicaidmental health service are less likely toreport external or internal collaboration (Figure4). Fewer than one-third (31 percent) ofthe States where the mental health agency hasrate-setting authority reported frequent collaborationon external projects, while morethan two-thirds (69 percent) of the Stateswhere the mental health agency does nothave that authority report frequent collaboration.States where the mental health agencyhas rate-setting authority also are less likelyto report regularly scheduled meetingsbetween the agency directors (52 vs. 81 percent),or meetings at least monthly betweenthe two agency’s staffs (44 vs. 65 percent). Amental health agency with rate-settingauthority also was less likely to report thatthe Medicaid agency has a staff member whoserves as the point person on mental healthissues (60 vs. 85 percent), that Medicaid isrepresented on the State MHPC (76 vs. 88percent), or that a slot is reserved for a mentalhealth representative on the State MCAC(56 vs. 69 percent). However, both for Stateswhere the mental health agency has rate-settingauthority and for those that do not,there are roughly equal rates of Medicaidparticipation in the development of the MentalHealth Plan (72 vs. 69 percent).More than two-thirds of the respondentsfrom all States said that the relationshipbetween the Medicaid and mental healthagencies could be improved. States thatreported less frequent collaboration betweenthe agencies and those in which the mentalhealth agency has no authority to set anyMedicaid mental health rates are more likelyto think the relationship between the twoagencies could be improved.C. Other Factors AffectingCollaborationIn addition to the factors affecting collaborationthat were explicitly asked about in thesurvey, the interviews revealed a number ofother factors that can have an impact on collaboration.They are summarized below.1. Staff Movement Between AgenciesMany States noted that the movement ofstaff between the two agencies acts as anotherinformal collaborative device. Exampleswere cited of States where separate Medicaidand mental health agencies were previouslyunder the same umbrella agency and thereforevery familiar with the each other, whileothers are currently located in the same agency.However, this route to collaboration isnot always possible. One State respondentnoted that movement between agencies is discouragedby separate merit and promotionsystems. If employees from one agency transferto the other, they have to start over in themerit system and, in effect, suffer ademotion.2. State and Agency SizeAnother variable that appears to influencethe level of collaboration is the size of theState and the agencies within a State. Asnoted below, this relationship between Statesize and collaboration showed up more in theinterviews than in the formal measures ofcollaboration reported in the survey. In manyof the State interviews, the respondents fromsmaller agencies and less densely populatedStates reported a degree of informal collaborationthat appeared to exceed that describedby respondents from larger agencies andStates. In some cases, the collaboration44 Administration of Mental Health Services by Medicaid Agencies
etween the agencies is higher because oftheir physical office proximity, but moreoften than not this level of cooperationappears to be a product of their environment.One State respondent said, “Because we’re asmall State, we all know each other in termsof our entire lives.” As a result, “we haverelationships where [the Medicaid directorcan] just pick up the phone and work it out”if a problem arises. The respondent in anotherState said that the two agencies have an“excellent working relationship” because“we’re a small handshake State.” Anotherrespondent from a small State said thatbecause “everyone in this State knows everyoneelse,” if there is a problem it will beaddressed.This relationship between collaborationand State size was difficult to quantify withthe collaboration measures used in the survey,however. Small and large States wereequally likely to report “frequent” collaboration,and the smaller States tend to havefewer formal mechanisms to facilitate thatcollaboration, as seen in Figure 5. One interpretationis that degrees of collaboration arecontext-specific, so that what looks like frequentcollaboration in a large State may beviewed as just part of normal day-to-daybusiness in a small State. It may also be thecase that collaboration requires more formalmechanisms in large States than in smallones.3. Personal RelationshipsWhile the formal devices used to maintaincoordination between State mental healthand Medicaid agencies are helpful in facilitatingworking relationships, States reportedthat most relationships are dictated by moreinformal mechanisms. As one respondentsaid, “The informal is just as important asthe formal.” This respondent added thatwhen it comes to understanding how Medic-Administration of Mental Health Services by Medicaid Agencies 45
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 56 and 57: The Medicaid director in one State
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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