Administration of Mental Health Services by Medicaid Agencies

are in separate agencies in 23 States. SevenStates reported having more than one Statelevelmental health agency. In the vast majorityof States, two or fewer reporting levelsseparate the Medicaid director from theGovernor.In terms of funding, the State match forMedicaid mental health services comes atleast partially from the mental health agencyin 32 States. In 22 States, some funding forMedicaid mental health services comes fromcounties or other local sources. In 23 States,the Medicaid agency has a separate line itemin the budget for mental health services. Inalmost half the States, the mental healthagency has the authority to set some Medicaidmental health rates, most commonly forresidential treatment, psychiatric social workers,targeted case management, and psychosocialrehabilitation.States were fairly consistent in their definitionof mental health services for Medicaidfunding purposes, with all States includingoutpatient services provided by psychiatric ordesignated mental health providers and morethan 80 percent of States including servicesprovided at community mental health centers(CMHCs), services provided under the rehabilitationoption, inpatient services in a psychiatrichospital, and inpatient mental healthservices in a general hospital.States tended to be somewhat restrictive intheir definition of mental health providers,with 26 States requiring that providers have amental health or psychiatric designation and22 States requiring some or all Medicaidmental health providers to be enrolled or certifiedthrough the mental health agency.Twenty-five States reported that at leastsome Medicaid mental health services orpopulations are covered through behavioralhealth organizations (BHOs) that provide servicesthrough a capitated managed carearrangement or through administrative servicesorganizations (ASOs) that provide theseservices on a nonrisk fee-for-service basis. Ofthe 26 States that report not using a BHO orASO, 12 carve out or exclude at least somemental health services or populations frombroader Medicaid managed care programs.Only 10 States use none of these managedcare arrangements.2. Data and ReportingForty States reported that the Medicaid agencyproduces formal reports that contain discretedata on mental health utilization orexpenditures, including utilization and costby service (29 States) and cost per beneficiary(26 States). In 27 States the mental healthagency produced reports on Medicaid mentalhealth spending or utilization. At least someof these reports are publicly available in 30of the States, while in 7 States all reports areinternal only.Over three-quarters of the States makedata from the Medicaid Management InformationSystem (MMIS) available to the mentalhealth agency for analysis. The data in theMMIS on Medicaid clients and services werelinked at the client level to mental healthagency client-level data in 16 States for eitheradministrative or policy analysis purposes.3. Collaboration Between Medicaid andMental Health AgenciesSlightly more than half of the States interviewedreported that the Medicaid agencyand mental health agencies collaborate frequentlythrough external meetings, publicreports, or presentations to the legislature.In terms of internal collaboration, 17States hold weekly or biweekly meetingsbetween the staff of the Medicaid and mentalhealth agencies, and 18 other States reported58 Administration of Mental Health Services by Medicaid Agencies