The report is the outcome of meetings convened by the Bazelon Center for Mental Health Law and the Milbank Memorial Fund with senior government officials in states whose Medicaid programs have shifted to managed behavioral health care. The report describes positive effects, including an expanded array of services, less use of inappropriate inpatient care, more goal-directed treatment, and increased emphasis on accountability and outcomes. Cost-shifting is highlighted as a particularly serious problem. When managed care contractors deny access to needed mental health services, states still pay for the consequences of neglect if child welfare, criminal justice or other public agencies have to step in.
Integration is the fundamental solution, the report points out.
Some of the states that have undertaken integration have integrated mental health and social services, while others have tried to align the health and mental health systems. The report discusses the pros and cons of these approaches. However, the report explains, the performance and outcome measures demanded by managed care will ultimately provide better accountability and enable a state to know whether its goals are being reached. Although the authors found few clear patterns in how states have deployed managed care, they note that some states are now reconsidering their initial reliance on private managed care entities for public mental health and addiction services. Instead they are adopting the techniques of managed care in varying blends of public and private plans.