The question of coordination is made more complicated in a managed care context by the fact that many public agencies have limited budgets and depend heavily on Medicaid funds to pay for covered services which their clients need. Where these services are furnished directly by local health agencies, the shift to managed care may also be costing the agency needed revenues, thereby increasing the problem. 4.1 Agency Relationships Criteria Table 4.1 presents information on how states approach the issue of agency relationships in the case of state and local public health agencies, state and local mental health and addiction treatment agencies, state senior service programs, early intervention, special education, children with special health care needs, WIC, school health clinics, homeless health care programs, child welfare agencies, adult welfare agencies, juvenile justice agencies, and adult correction agencies. These agencies reflect the full range of agencies typically interacting with the Medicaid population both during periods of enrollment in managed care and during periods of uninsurance. As we found in our previous studies, while there are numerous examples of state efforts to specify some level of relationship, in fact most states give plans considerable discretion to determine the extent and components of their agency relationships.
Contracts often define the relationships in terms of recommendations rather than requirements.
The following examples offer a sense of the range of state expectations around health plan relationships with public agencies. The state of California offers one of the most comprehensive examples of state expectations regarding relationships between health plans and public health agencies. Florida s and California s contracts both specify that plans must reimburse local health agencies for certain personal health services under certain circumstances. Hawaii requires that plans contract with community mental health centers but leaves the scope of involvement to plan discretion. Similarly, Oregon states that the MCO shall have written policies and procedures for coordinating services for enrollees who require services from more than one local or regional organization but does not specify the scope of the involvement.