Administration of Mental Health Services by Medicaid Agencies

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4.2 million for all States, and three of theStates have more than 10 million people.1. Managed Care for Medicaid-FundedMental Health Services in States with LowerMedicaid Agency AuthorityThree of the five States (Michigan, Oregon,and Washington) reported using a BHO oran ASO to provide mental health services,and also reported that at least some mentalhealth services or populations are carved outof general Medicaid managed care contracts.The other two States (California and Ohio)reported not using a BHO or ASO for mentalhealth services.In California, Medicaid mental health servicesare administered through the mentalhealth agency and delivered by county mentalhealth departments that act as mental healthplans. All Medicaid mental health providersmust be employees or contractors of thecounties. In Washington, Medicaid mentalhealth services are provided through managedcare organizations called regional servicenetworks (RSNs). Capitated payments toRSNs cover services to Medicaid eligiblesthrough a county-based network of CMHCsand clinics. In Oregon, Medicaid mentalhealth services are administered by nine mentalhealth managed care organizations underan 1115 waiver.2. Other Common Issues and ProjectsSurvey respondents cited relatively few specificexamples of work on common projects inthese States. Oregon and Michigan respondentsmentioned that the Medicaid and mentalhealth agencies are jointly examining psychotropicand/or substance abuse drug prescribingpatterns.F. Some Patterns and CorrelationsWhile the States with relatively lower levelsof Medicaid authority over mental health serviceswere not more likely to be on the higher-collaborationend than the lower-collaborationend of that spectrum, they were in aposition to work together with the mentalhealth agency (they were in the same umbrellaagency in four of the five States), and therewere more indicators of collaboration inthese States (meetings, data sharing, funding)than in the States with relatively higher Medicaidagency authority. In addition, the factthat the Medicaid agency has delegated significantauthority for administration of Medicaidmental health services to the mentalhealth agency (one of the measures used toidentify States with lower Medicaid authority)suggests that the public mental health systemin these States has the infrastructureneeded to handle this responsibility.One of the notable characteristics of theStates on the opposite ends of the relativeMedicaid authority spectrum is the differencein average population sizes. Larger Statesappear to delegate more Medicaid authorityto the mental health agency, perhaps reflectingthe availability of a more well-developedpublic mental health system in those States.Several of the smaller States with relativelyhigher Medicaid agency authority, by contrast,said in the interviews that finding anadequate supply of mental health providers,particularly in rural areas, was a perennialproblem, suggesting a less-developed publicmental health system.Data sharing and reporting was notstrongly correlated with the level of relativeauthority. On both ends of the spectrum,most States gave the mental health agencyaccess to the MMIS, but not many linked54 Administration of Mental Health Services by Medicaid Agencies
client-level data between the Medicaid andmental health agencies.G. SummaryClassification Methodology. Eight States wereclassified as having relatively higher levels ofcollaboration between State Medicaid andmental health agencies and eight States ashaving relatively lower levels of collaboration,based on measures such as the numberof regular meetings, self-reported frequencyof collaboration, and sharing of data. FourStates were classified as having relativelyhigher levels of Medicaid agency authorityover Medicaid-funded mental health servicesand five States as having relatively lowerMedicaid agency authority, based on measuressuch as responsibility for mental healthservices funding, rate setting, and providercertification.One of the four States in which the Medicaidagency has delegated a relatively higherlevel of authority to the mental health agencywas in the higher-collaboration category andone was in the lower-collaboration category,while none of the five States with relativelyhigh Medicaid agency authority was in thehigher- or lower-collaboration categories.Higher-Collaboration States. The eightStates in the higher-collaboration categoryare more likely to have Medicaid and mentalhealth under the same umbrella agency. Themental health agency does not set Medicaidrates in any of these States. These States oftenhave specific projects on which both agencieswork, in some cases involving Medicaid managedcare.Lower-Collaboration States. The eightStates in the lower-collaboration category aremore likely to have Medicaid and mentalhealth in separate agencies and less likely tohave the mental health agency participate inthe certification of mental health providers orissuing reports. These States often are characterizedby a fragmentation of responsibilitywithin the State mental health agency, as wellas by few cross-agency working groups.States with Higher Medicaid AgencyAuthority. In the four States in which theMedicaid agency has relatively higher authorityover mental health services, the Medicaidand mental health agencies tend to operateseparately in a number of ways (fewer meetings,less mental health funding of Medicaidservices, separate agencies in two of theStates). There is very little managed care inthese States, and the populations are relativelysmall.States with Lower Medicaid AgencyAuthority. The five States with relativelylower Medicaid agency authority over mentalhealth services are more likely to have Medicaidand mental health under the sameumbrella agency (four of the five) and aremore likely to report several indicators ofcollaboration. Three of the five States reportedusing a BSO or ASO to provide Medicaidmental health services, and three of the Stateshave very large populations.Administration of Mental Health Services by Medicaid Agencies 55
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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
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Executive SummaryState Medicaid age
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I. IntroductionState Medicaid agenc
Page 17 and 18: with Medicaid playing a more promin
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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
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Page 34 and 35: Thirty-nine States classified psych
Page 36 and 37: Table 4: Medicaid Mental Health Pro
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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 66 and 67: programs and are provided in either
Page 71 and 72: V. Summary and ConclusionsThe surve
Page 73 and 74: less frequent but still regularly s
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Page 87 and 88: Table A.3: Managed Care, continuedS
Page 89: Table A.4: Data, continuedState MMI
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