The data collection involved three phases: (1) selection of state Medicaid programs that have implemented strategies to improve the coordination of behavioral health, physical health, and housing services; (2) document review and discussions with stakeholders in selected states to identify the key features of state programs; and (3) site visits to gather stakeholders' perspectives on the strengths and limitations of the program.
A. State Selection
States had to meet the following inclusion criteria: (1) have an explicit strategy for coordinating behavioral and physical health care services for Medicaid beneficiaries with behavioral health needs; (2) design the strategy as a single financing arrangement at the state level (or consistently across regions); (3) incorporate coordination of behavioral health and housing services into the financing arrangement; and (4) be in operation long enough for respondents to provide their perspectives on program design and implementation successes, challenges, and lessons.
We conducted outreach to a broad range of organizations and experts to identify potential states for the study, including state and federal Medicaid and behavioral health representatives, and state policy and housing experts at the Center for Health Care Strategies, the Technical Assistance Collaborative, and the National Association of County Behavioral Health and Developmental Disability Directors. These experts identified 11 state programs as possible candidates for the study. We then conducted an environmental scan to gather additional information about the key features of the candidate states, which involved searching the websites of MCOs and state Medicaid and behavioral health agencies. Using this information, we excluded states that did not meet all of the inclusion criteria. We also attempted to achieve geographic diversity and select states that were in different stages of implementation but had enough experience to share. In collaboration with ASPE, we selected Illinois, Louisiana, Massachusetts, and Tennessee.
B. Data Collection
To answer the research questions, we relied on data from: (1) document review including websites, reports, provider manuals, managed care contracts, and news releases; (2) semi-structured telephone interviews with state Medicaid and/or behavioral health agency officials and managed care representatives; and (3) two-day site visits that included in-person interviews with providers (including housing providers) and consumer representatives. Phone discussions and in-person meetings focused on gathering information about the context in which the initiative was developed, changes in the accessibility and quality of care, the mechanisms used to finance and coordinate physical, behavioral health, and housing services, provider and consumer experiences with the strategy used in each state, perceived health and social outcomes, the availability and use of data for care coordination and quality improvement, and any general successes and challenges.