The number of States with public sector managed behavioral health care programs has tripled in three years. While Medicaid agencies most often serve as the primary purchaser for managed behavioral health care programs, State mental health and substance abuse authorities work in collaboration with Medicaid agencies, particularly for carve-out programs. Medicaid agencies act as the purchaser in 93 percent of States with integrated programs, compared with 69 percent of States with carve-outs. Integrated programs most often contract with private sector managed care organizations. Public sector managed care organizations are more prevalent in carve-out programs.
Counties dominate among all types of public sector contractors, regardless of model.
Financing Medicaid is the largest source of funding for public managed behavioral health care programs. Ninety-eight percent of all States with managed behavioral health care programs use Medicaid to either fully or partially fund their programs. Medicaid finances integrated programs almost exclusively. ASO contracts account for seven of the 12 States using fixed fees.