Administration of Mental Health Services by Medicaid Agencies

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A. State ClassificationsThe State classifications were developed byusing clusters of characteristics that indicaterelatively higher or lower levels of collaborationand relatively higher or lower levels ofMedicaid agency authority over Medicaidmental health services.1. CollaborationFirst, five measures of “higher collaboration”and four measures of “lower collaboration”were identified, and States were ranked onthem. The measures are formal indicationsof both internal and external collaborationbetween the Medicaid and State mentalhealth agencies, as well as of data sharingbetween them. There are eight States whereat least four of the five higher-collaborationmeasures were present and eight States whereat least two of the four lower-collaborationmeasures and only one or fewer of thehigher-collaboration measures were present.These States were designated the highercollaborationand lower-collaboration States,respectively.There were 35 States that did not scorehighly on either the higher- or lowercollaborationmeasures, so they were notdesignated as either higher- or lowercollaborationStates.Limitations of the Collaboration Measures.Since the survey did not explicitly askrespondents to characterize the overall degreeof collaboration between Medicaid and mentalhealth agencies in their State, and sincerespondents generally are not familiar enoughwith other States to rank themselves on thisdimension, the measures outlined above arenecessarily indirect and incomplete. Theyindicate whether some formal structures thatcould facilitate collaboration are in place andwhether some specific kinds of collaborativeactivities have occurred, but they do not measureless formal activities such as ad hocmeetings or personal relationships betweenagency heads. In addition, since the surveyrespondents were primarily from the StateMedicaid agency, a different picture of thedegree of collaboration between Medicaidand mental health agencies in particularStates might result if respondents from Statemental health agencies were surveyed.2. AuthorityFive measures, shown below, measure theextent to which States have delegated significantaspects of the administration of Medicaidmental health services to the mentalhealth agency and are thus using the publicmental health system to some extent to deliv“Higher-Collaboration” Measures• Regular meetings between agency directors• Meetings between agency staff either weeklyor more often• Self-reported “frequent” collaboration• One or more “very influential” work groups inwhich both agencies participate• Links between Medicaid and mental healthdata“Lower-Collaboration” Measures• Meetings between staff at the two agencieseither quarterly or less often• Self-reported “occasional” collaboration• Medicaid agency does not participate in thedevelopment of the State mental health plan• Medicaid agency does not make MMIS dataavailable to the mental health agency• No more than one “higher-collaboration”measure is present48 Administration of Mental Health Services by Medicaid Agencies
er Medicaid services. States where few ofthese measures are present appear not tohave delegated significant authority for mentalhealth services to the public mental healthsystem. The five States where all five measuresof delegation of Medicaid authority tothe mental health agency are present are classifiedas “lower Medicaid agency authority”States, while the four States where none ofthe measures is present are classified as“higher Medicaid authority” States.Most States fell between the two endsof the authority spectrum. Closer to the“higher Medicaid authority” end of the continuum,there are 7 States where only onemeasure of delegated authority is presentand 17 States where two of the five measuresare present. Closer to the “lower Medicaidagency authority” end of the continuum,there are 5 States where four of the fivemeasures of delegated authority are presentand 13 States where three of the five measuresare present.“Lower Medicaid Agency Authority” Measures• At least some funds for Medicaid mentalhealth services come from a source differentfrom other Medicaid funds• Mental health providers are paid differentlyfrom other providers• Mental health agency has authority to setmore than one rate or sets the capitationrate for mental health services• At least some mental health services or populationsare carved out of regular Medicaid• Mental health providers are certified orenrolled into Medicaid differently from otherproviders3. Summary of Collaboration and AuthorityClassificationsThere were 23 States that could be classifiedas being on the higher or lower end of thecollaboration or authority dimensions. Ingeneral, there did not appear to be a patternbetween level of collaboration and the levelof Medicaid authority. All States with lowerMedicaid authority over mental health serviceswere on neither the higher nor lower endof the collaboration spectrum; most Stateswith higher Medicaid authority were alsoneither higher- nor lower-collaborationStates, with only one higher-authority Statealso in the higher-collaboration category andone higher-authority State in the lowercollaborationcategory.The 23 States that fell at the higher orlower end of the collaboration or authoritydimensions were analyzed to explore whetherthey have other characteristics in common ormay have opportunities to work together onspecific issues or projects. Responses to theopen-ended questions on the survey wereused to obtain additional information on specificcollaborative activities or opportunities.This analysis is detailed in the remainder ofthis chapter.B. States with Relatively HigherLevels of Medicaid-Mental HealthAgency CollaborationThe eight States that were on the higher endof the collaboration dimension (Louisiana,Massachusetts, Nevada, New Mexico, NorthCarolina, Oklahoma, Pennsylvania, and Wisconsin)also have other features in common:■■The Medicaid and mental health agenciesare in the same umbrella agency in six ofthe eight States.All scored highly on other measures ofcollaboration:Administration of Mental Health Services by Medicaid Agencies 49
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Administrationof MentalHealthServic
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AcknowledgmentsThis report was prep
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III. Medicaid Agency Collaboration
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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 60 and 61: aid and mental health work together
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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