Improving the Coordination of Services for Adults with Mental Health and Substance Use Disorders: Profiles of Four State Medicaid Initiatives
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Associated Project
Innovative State Systems Supporting Coordinated Services for Individuals with Mental and Substance Abuse Disorders
Prepared for:
U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation
Office of Disability, Aging, and Long-Term Care Policy
Key Findings
Key Findings:
- These states are moving toward greater reliance on Medicaid managed care entities to coordinate care, which has involved expanding and integrating benefits at the health plan level and creating reimbursement mechanisms that support in-person care coordination. When moving to managed care, states have had to consider ways to minimize disruption of provider billing processes and ensure that service definitions and eligibility criteria support access to ongoing comprehensive coordinated care. In some states, these issues continue to present challenges.
- In-person care coordination provides a critical service to individuals with serious mental health and substance use disorders. Medicaid benefits in these states include reimbursement for case management and other in-person supports (such as Assertive Community Treatment) for beneficiaries with the most serious needs. Stakeholders in these states, particularly providers, noted that telephonic care coordination alone does not provide a sufficient level of support for this population.
- These initiatives recognize that the success of their strategies depends on the strength of provider buy-in and local partnerships, and have taken steps to foster local collaborations. Stakeholders stressed that smooth implementation of care coordination strategies requires strong communication among providers, MCOs, state agencies, and consumer organizations.
- Stakeholders in these states stressed the importance of data-sharing to inform care coordination decisions at the provider level and to identify opportunities for quality improvement. The availability of data and capacity of providers and other stakeholders to use data for care coordination and quality improvement varies widely across states. Some states, particularly those with managed care arrangements, have more robust data to track service utilization and monitor quality. In other states, data-sharing between providers and/or other entities is more limited, due in part to the lack of common data platforms.
Medicaid beneficiaries with mental health and substance use disorders require an array of physical, behavioral health, and other supportive services. In the absence of comprehensive coordinated services, these individuals often receive costly inpatient and emergency care and experience negative social and health outcomes, including homelessness and premature mortality.
Historically, the financing and delivery of physical, behavioral health, and other supportive services have been fragmented. Within Medicaid programs, physical and behavioral health services have often been provided through different financing arrangements with inadequate coordination across state and local agencies and managed care plans. In many states and communities, housing supports and other social services are delivered through various providers who have difficulty coordinating care with physical and behavioral health providers. Some states, however, are undertaking efforts to improve the coordination of care for Medicaid beneficiaries with behavioral health conditions at the state and local levels.
The Office of the Assistant Secretary for Planning and Evaluation within the U.S. Department of Health and Human Services contracted with Mathematica Policy Research to conduct case studies to describe the financing arrangements and delivery system mechanisms that four states are using in their efforts to improve the delivery of comprehensive coordinated care for Medicaid beneficiaries with behavioral health conditions.
- Illinois: The state Medicaid program is supporting regional care coordination entities that include behavioral health and housing providers to implement in-person care coordination models. The state hopes that managed care organizations (MCOs) will ultimately contract with these new entities to provide more intensive care coordination for individuals with chronic behavioral health conditions.
- Louisiana: The state expanded the scope of Medicaid mental health and substance abuse benefits and contracted with a single statewide managed behavioral health organization (MBHO) to administer all specialty behavioral health services. These changes are intended to ensure that a single entity is responsible for the coordination of services, including housing supports.
- Massachusetts: As part of its capitated payment to a MBHO, the state Medicaid program reimburses care coordination support for chronically homeless individuals in permanent supportive housing. The state is hoping to expand this program to other MCOs.
- Tennessee: The state Medicaid program has integrated physical health, mental health, and substance abuse benefits within its managed care contracts; MCOs now operate on an at-risk basis for these services along with long-term care services.
Despite the structural differences of these strategies, this study identified several common themes across states.
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