Program on Mental Health and Substance Abuse Systems and Services Research

Evaluation Consortium on Medicaid Managed Care for Persons with Severe Mental Illness

This one-year project was supported by a grant from the Center for Health Care Strategies (CHCS), Inc. Its goal was to develop information about service use, costs, and outcomes for persons with a severe mental illness (SMI) under Medicaid managed care versus fee-for-service arrangements. It is an outgrowth of the SAMHSA Managed Care and Vulnerable Populations Study (see Completed Projects). Four specific aims were accomplished:

1. To develop a conceptual framework for assessing and comparing the performance of Medicaid managed care programs;
2. To employ this framework in the analysis of multi-state data on the use, cost, quality, and performance outcomes of a range of Medicaid managed care programs for persons with SMI;
3. To convene round table discussions among policy analysts, Medicaid directors, public mental health administrators, and researchers to critically appraise these findings and develop recommendations for the next generation of Medicaid financing strategies;
4. To disseminate these findings and recommendations to a variety of public sector audiences interested in improving the operation of the Medicaid program for SMI persons and other vulnerable populations.

This project was stimulated by the policy concerns that continue to be raised as to whether vulnerable populations, such as persons with SMI, are disadvantaged by the rapid transition to Medicaid managed care programs. This proposal--involving eleven sites in five states: Florida, Hawaii, Oregon, Pennsylvania, and Virginia--provided a comprehensive assessment of these issues across a range of for-profit and not-for-profit managed care programs. It also developed strategies for more informed evaluations of Medicaid program performance in the future and disseminate them widely in the practice and policy research arenas.Consortium members are drawn from a number of leading public and private universities; all have been key members of the local research teams that conducted the Medicaid SMI evaluations, and are experienced mental health services researchers.

The core activity was a set of six round-table meetings to facilitate the analyses and dissemination of the multi-site data. Specific plans for analysis and interpretation of the data flowed from these meetings as well as the design of dissemination products that are likely to effect Medicaid mental health administration throughout the nation. The six meetings were organized into three topical areas: Purchasing and Contracting Arrangements; Quality of Care; and Cost and Efficiency of Care Delivery. Two meetings will be held in each topical area; scheduled to allow for a three month window between the paired meetings. These meeting will be hosted by the Florida Mental Health Institute in Tampa, FL.