Administration of Mental Health Services by Medicaid Agencies

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programs and are provided in either fee-forserviceMedicaid or through the BHO orASO. The four other States do not use aBHO or ASO to deliver any mental healthservices. However, the District of Columbiadoes provide Medicaid physical and mentalhealth services to Supplemental SecurityIncome (SSI) children through a capitatedmanaged care organization.Three of the eight lower-collaborationStates (Mississippi, Montana, and SouthDakota) did not have any form of capitatedcomprehensive Medicaid managed care programas of June 2005 (CMS, 2005). In theNation as a whole, only 15 States (30 percent)did not have such a program inmid-2005.2. Other Common Issues and ProjectsOnly two of the eight States (Hawaii andMississippi) reported that working groups areaddressing specific problems common toMedicaid and mental health. Two of theStates with working groups where both Medicaidand mental health agencies are represented(Delaware and Utah) reported that thegroups generally do not focus on specificcommon problems. None of these four Statesreported that the working groups are “veryinfluential.”The other four States either have no workinggroups (the District of Columbia andSouth Dakota), or have groups in which onlythe Medicaid agency (Colorado) or the mentalhealth agency (Montana) participate.Since 47 States reported having Medicaidand/or mental health working groups, thiswas not used as a separate measure of collaboration.It is therefore worth noting that twoof the four States without working groupsalso ranked lower on the collaborationdimension, further underscoring the apparentreduced level of collaboration in those States.3. Fragmentation of ResponsibilityIt is also worth noting that four of the eightStates with relatively lower levels of collaborationhad at least some fragmentation ofresponsibility within the mental healthagency:■■Three of the States (Delaware, Hawaii,and Montana) have more than one mentalhealth agency.Utah has only one State mental healthagency, but the Medicaid agency dealswith a number of strong county-level mentalhealth agencies more frequently thanwith the State agency, potentially creatinga similar fragmentation problem.D. States with Relatively HigherLevels of Medicaid Agency Authorityover Mental Health ServicesThe four States with relatively higher levelsof Medicaid agency authority over Medicaidmental health services, and correspondinglylower mental health agency authority (Arkansas,North Dakota, Oklahoma, and SouthDakota) have several other characteristicsworth noting:■■■■The Medicaid and mental health agenciesare under the same umbrella agency inonly two of the four States.Only two of the four have regularly scheduledmeetings monthly or more often, andonly two of the four have directors whomeet regularly.All four have a Medicaid staff memberwho acts as the “point person” on mentalhealth policy within the Medicaid agency.None of the Medicaid agencies reported aline item for mental health services in theMedicaid budget, and in only one State52 Administration of Mental Health Services by Medicaid Agencies
■■did the mental health agency fund Medicaidservices.Three of the four States gave the mentalhealth agency access to the MMIS, andone State reported that the Medicaid andmental health agencies linked client-leveldata.In two of the four States, the mental healthagency produces reports on Medicaid mentalhealth services.■ All four States had populations of lessthan 4 million.One of these States is in the lower-collaborationcategory (South Dakota), and one is inthe higher-collaboration category (Oklahoma).As noted earlier, these formal measuresof collaboration may not account fully forthe informal collaboration that can take placein smaller States. The seven States in this categoryof higher Medicaid agency authorityhave an average population of just 1.9 million,and the largest State has a population of3.5 million, compared to a median State populationof 4.2 million for all States.1. Managed Care for Medicaid-FundedMental Health Services in States with HigherMedicaid Agency AuthorityOnly one of the four States reported using aBHO or ASO to provide mental health services.In North Dakota, a commercial Medicaidmanaged care organization operating inthree counties provides both mental andphysical health services on a capitated basisto around 750 enrollees, or about 1.5 percentof the Medicaid population in the State.2. Other Common Issues and ProjectsNorth Dakota has a working group thatmeets primarily to discuss children’s mentalhealth issues, but it also serves as the defaultgroup when local and regional offices cannotsolve problems in individual cases.E. States with Relatively LowerLevels of Medicaid Agency Authorityover Mental Health ServicesThe five States in which the Medicaid agencyhas delegated relatively large amounts ofauthority for administration of Medicaidmental health services to the mental healthagency (California, Michigan, Ohio, Oregon,and Washington) have several other characteristicsworth noting:■■■■■■■In four of the five States, the mental healthagency is under the same umbrella agencyas the Medicaid agency.Four of the five States hold meetingsbetween Medicaid and mental health agencystaff monthly or more often, and all fivehave regularly scheduled meetings betweenthe directors of the two agencies.Only three of the five Medicaid agenciesare represented on the State Mental HealthPlanning Council, and only two have a“point person” on mental health issueswithin the Medicaid program.Three of the five States have a line item formental health services in the Medicaidbudget, and the mental health agencyfunds Medicaid services in four States.All five States allowed the mental healthagency to access the MMIS, although onlyone State had linked client-level databetween Medicaid and mental health.In four of the five States, the mental healthagency creates reports about Medicaidmental health data.These States tend to be larger, with anaverage population of 13.5 million, comparedto the median State population ofAdministration of Mental Health Services by Medicaid Agencies 53
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Administrationof MentalHealthServic
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AcknowledgmentsThis report was prep
Page 8 and 9:
III. Medicaid Agency Collaboration
Page 10 and 11:
Tables12345678Organizational Struct
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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 62 and 63: A. State ClassificationsThe State c
Page 64 and 65: ■- The Medicaid agency participat
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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