Administration of Mental Health Services by Medicaid Agencies

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aid and mental health work together, muchof their collaboration is based on personalrelationships rather than formal structures.Numerous respondents noted that interagencyrelationships tend to fluctuate dependingon the compatibility of the agency leaders. Inone State, the Medicaid and mental healthdirectors, participating jointly in the phoneinterview, emphasized their strong personalrelationship by noting that they had hadThanksgiving dinner together. Although thisexample may not be typical, the importanceof strong personal relationships betweenagency heads was echoed in many other Stateinterviews.One respondent put it succinctly by reportingthat the agency leadership is “playingreally well together right now. It’s all aboutpersonalities, and right now it’s good.” Arespondent from another State remarked thatthe relationship between the two agencies is“at an all-time high” but that things were abit adversarial before the two current directorswere in place. Similarly, the respondentfrom another State discussed the troubledrelationship between the two agencies 4 yearsago, but said that the current directorsworked well together.The survey results may actually understatethe importance of these relationships, sincenone of the questions explicitly addressed thisissue. One reviewer of a draft of the reportnoted that as Medicaid director he met fairlyoften with the mental health director in informalsettings in which policy issues were discussed(breakfast, lunch, dinner), but he didnot think of these as “regularly scheduledmeetings” when responding to the surveyquestion on meetings between agency heads.relationships between State Medicaid andmental health agencies, noting that theycould sometimes lead to heightened tensionsbetween the two agencies.D. SummarySlightly more than half of the respondentsreported that the Medicaid and mental healthagencies collaborate frequently through externalmeetings, public reports, or presentationsto the legislature. In terms of internal collaboration,17 States hold weekly or biweeklymeetings between the staff of the Medicaidand mental health agencies, and 18 otherStates reported less frequent but still regularlyscheduled meetings. Thirty-four States reportedregularly scheduled meetings between thedirectors of the Medicaid and mental healthagencies. Joint participation in formal workgroups is widespread, although the Medicaidagency is more likely to participate in groupsformulating mental health policy than thereverse. Several less formal factors affect collaboration,including staff movement betweenagencies, State and agency size, personal relationships,and Federal rules and limitations.4. Federal Rules and LimitationsMany respondents cited Federal Medicaidrules and limitations as important factors in46 Administration of Mental Health Services by Medicaid Agencies
IV. A Closer Look at Some Specific Types ofStatesAs indicated in the preceding chapters, States have taken a variety ofapproaches to providing mental health services through Medicaid.The relationship between the Medicaid and mental health agenciesand the degree of collaboration between them varies substantially from Stateto State. Some States make extensive use of the public mental health systemto administer Medicaid mental health services, while others largely bypassthe mental health system, choosing instead to treat mental health servicesin essentially the same way as physical health services within the Medicaidprogram.This chapter uses the State characteristicsand activities discussed in Chapters II and IIIto categorize States on two dimensions: bythe level of collaboration between Medicaidand mental health agencies, and by the relativeauthority of these agencies with respectto Medicaid-funded mental health services. Itthen looks at additional characteristics thatare associated with States that are at eitherend of the collaboration and authority spectrumsand examines how these States dealwith Medicaid managed care and other commonissues and projects.Looking at States that are at the ends ofthese spectrums can help to identify some ofthe strengths and limitations of differentState approaches to dealing with Medicaidand mental health services. States that maywant to move in different directions can seesome of the potential implications of doingso and can look to specific States as modelsof where they might want to go or avoidgoing.This chapter first describes the methodologythat was used to classify States on thedimensions of collaboration and authority,and then it looks more closely at how specificStates that fall on either end of the collaborationor authority spectrums deal with a varietyof Medicaid mental health service issues.Since the classifications are designed to identifydistinct State types, the majority of States(28) that fall closer to the middle of thesetwo spectrums are not discussed in this chapter.In addition, as discussed further below,the measures used to classify States haveinherent limitations, since a single survey cannotcapture or give appropriate weight to allof the variables that may be relevant in eachState or group of States.Administration of Mental Health Services by Medicaid Agencies 47
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Administrationof MentalHealthServic
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AcknowledgmentsThis report was prep
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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 58 and 59: have the Medicaid agency represente
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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Administration of Mental Health Services by Medicaid Agencies

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