全球智库信息集成服务系统

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.