Administration of Mental Health Services by Medicaid Agencies

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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
less frequent but still regularly scheduledmeetings. Thirty-four States reported thatthere were regularly scheduled meetingsbetween the directors of the Medicaid andmental health agencies.Joint participation in formal work groupswas widespread, although Medicaid wasmore likely to participate in groups formulatingmental health policy than the reverse.Thirty-six States reported that the Medicaidagency participates in the development of theState Mental Health Plan, and 37 States havea Medicaid staff member who serves as the“point person” on mental health issues. Aslot is reserved on the State Medicaid MedicalCare Advisory Committee (MCAC) for amental health representative in 32 States, butthe slot was usually filled by a provider or aconsumer representative rather than by a representativeof the State mental health agency.4. A Closer Look at Some Specific Types ofStatesA number of States could be identified asoutliers in terms of the degree of collaborationbetween Medicaid and mental healthagencies or the relative authority of the twoagencies over Medicaid-funded mental healthservices. The States on either end of thesespectrums illustrate some of the characteristicsand potential consequences of differentapproaches to Medicaid funding and administrationof mental health services.a. Higher-Collaboration StatesEight States ranked especially high on measuresof Medicaid and mental health agencycollaboration: Louisiana, Massachusetts,Nevada, New Mexico, North Carolina,Oklahoma, Pennsylvania, and Wisconsin.These States reported regular meetingsbetween agency directors and staff, “frequent”collaboration, one or more “veryinfluential” joint work groups, and linkedMedicaid and mental health data.These eight higher-collaboration States hadsome other characteristics worth noting,including having both agencies in the sameumbrella agency in six States.b. Lower-Collaboration StatesThere were eight States where collaborationbetween Medicaid and mental health agencieswas relatively low, based on low frequency ofstaff meetings, low self-reported levels ofcollaboration, no Medicaid participation indevelopment of the State mental health plan,no sharing of Medicaid data with the mentalhealth agency, and the absence of measuresof higher collaboration: Colorado, Delaware,the District of Columbia, Hawaii, Mississippi,Montana, South Dakota, and Utah.These eight lower-collaboration States alsohad other characteristics worth noting,including having the two agencies in separateState agencies in six of the States, regularmeetings between the agency directors in onlyfour of the States, and limited mental healthagency involvement in Medicaid mentalhealth provider certification and use of Medicaiddata.c. States with Higher Medicaid Agency AuthorityThere were four States where the Medicaidagency appeared to have a relatively higherlevel of authority over Medicaid mentalhealth services, based on limited mentalhealth agency authority over Medicaid mentalhealth rate setting and provider certificationand limited mental health agency fundingof Medicaid services: Arkansas, NorthDakota, Oklahoma, and South Dakota.These four States also had other characteristicsworth noting, including having Medicaidand mental health in the same umbrellaagency in only two of the States, havingAdministration of Mental Health Services by Medicaid Agencies 59
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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
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with Medicaid playing a more promin
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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
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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 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 66 and 67: programs and are provided in either
Page 68 and 69: 4.2 million for all States, and thr
Page 71: V. Summary and ConclusionsThe surve
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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