Improving the Coordination of Services for Adults with Mental Health and Substance Use Disorders: Profiles of Four State Medicaid Initiatives. Endnotes

02/27/2015

  1. Louisiana announced in November 2014 that it plans to integrate specialty behavioral health services into physical health managed care plans, starting in December 2015.

  2. Individuals maintain eligibility as long as they remain housed and enrolled in the MBHP-covered plan. A loss in eligibility occurs most notably when a CSPECH participant becomes dually eligible for Medicaid and Medicare. Dually eligible individuals are not eligible for the MBHP-covered plan. As of the writing of this report, none of the available plans for dually eligible individuals covers CSPECH services.

  3. The amount of the PMPM is not publicly available.

  4. The state uses an algorithm that auto-enrolls the most expensive Medicaid beneficiaries to the CCEs, including a large proportion whoare homeless. Individuals dually eligible for Medicare and Medicaid are ineligible for CCE enrollment.

  5. During an open enrollment period, Medicaid members must contact the Illinois Client Enrollment Broker to enroll in either a CCE or in one of the many managed care options. The state auto-enrolls those who do not contact the Broker in an MCO or CCE. Individuals who select to enroll or are auto-enrolled with a CCE are not served by an MCO. The state pays all services, using a fee-for-service arrangement.

  6. Applicants who are no longer eligible have been removed from the wait list. Participants who were previously housed but would no longer qualify are still being served through CDBG funding.

  7. This report focuses exclusively on the mechanisms for serving adults with behavioral health conditions; PSH serves children and adults with long-term physical or developmental disabilities through different mechanisms.

  8. CSP is an outreach service aimed at engaging individuals who, by not complying with a treatment plan, are putting themselves at serious risk. CSP services are typically provided to individuals being discharged from a psychiatric hospital or detoxification facility. Recognizing the value of such interventions, MassHealth received Centers for Medicare and Medicaid Services approval, through its managed care waiver program, to allow them as a reimbursable service.

  9. MassHealth members have the option of enrolling with either one of six MCOs or in the state's primary care clinician (PCC) plan. Under the PCC plan, MassHealth directly reimburses a member's physical health services, and MBHP pays for behavioral health services. The six MCOs are responsible for covering a member's physical health and behavioral health services, although the latter typically are provided through a behavioral health partner of the MCOs. At the time of this report, CSPECH services are available only through the PCC/MBHP plan; none of the MCOs have opted to cover this service.

  10. Under the Housing First model, homeless individuals are moved directly into housing and offered a range of supportive services in an effort to maintain housing. The receipt of housing is not dependent on successful completion of treatment.

  11. Tennessee's CHOICES program includes nursing facility services and home and community-based services for adults 21 years of age and older with a physical disability, and seniors (age 65 and older).

View full report

Preview
Download

"4Initiative.pdf" (pdf, 488.91Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®