Blending Perspectives and Building Common Ground. Medicaid Managed Care Programs (1)

04/01/1999

Increasingly, States are using managed care programs for their Medicaid populations.  Managed care is emerging as the principal means for financing and delivering physical and behavioral health care services under Medicaid (Lewin Group, 1997).  As of the spring of 1997, a number of things could be said about substance abuse services in Medicaid managed care programs.  These include:

  • 33 States and the District of Columbia had Medicaid managed care waivers implemented or approved that included some form of behavioral health services:  Alabama, Arizona, California, Colorado, Connecticut, Delaware, the District of Columbia, Florida, Hawaii, Iowa, Kansas, Kentucky, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nebraska, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Dakota, Tennessee, Texas, Utah, Virginia, Vermont, Washington, and Wisconsin.  Fourteen of these States and the District provide behavioral health services through Section 1115 waivers.  Twenty-two of these States and the District do so using Section 1915(b) waivers.  (There is some overlap among these two groups.)
  • 30 of these 33 States and the District had the same or a greater scope of mental health and/or substance abuse benefits under the waivers, compared to their fee-for-service systems.
  • 13 States and the District of Columbia covered substance abuse services under approved or implemented Section 1115 waivers:  Alabama, Arizona, Delaware, Hawaii, Maryland, Massachusetts, Minnesota, Ohio, Oklahoma, Oregon, Rhode Island, Tennessee, and Vermont.
  • 14 States and the District of Columbia covered substance abuse services under approved or implemented Section 1915(b) waivers:  Connecticut, Iowa, Kansas, Kentucky, Massachusetts, Michigan, Minnesota, Missouri, Nebraska, North Carolina, Pennsylvania, South Dakota, Texas, and Wisconsin.
  • The following States specifically listed children for whom adoption assistance or foster care maintenance payments are made among their targeted populations for Medicaid managed behavioral health care waivers:  Arizona, Florida, Illinois, New Mexico, North Carolina, Ohio, Oregon, Pennsylvania, and Utah (inpatient services only).  Some other States include these children under broad populations covered under Medicaid managed behavioral health care waivers.

1.  Information in this section is derived from The Lewin Group (1997).  State Profiles on Public-Sector managed Behavioral Health Care and Other Reforms.  Washington, DC:  Substance Abuse and Mental Health Services Administration.