There has been a substantial movement nationwide toward managed care for Medicaid beneficiaries, initially for families but in recent years also for seniors and people with disabilities. Many states are requiring that people newly eligible for Medicaid in 2014 enroll in managed care plans, most of which are expected to cover both medical and behavioral health care. Risk-adjustment in setting capitation rates is a critical piece of the managed care puzzle for addressing the needs of people with complex conditions, including those with histories of chronic homelessness. Government officials, PSH providers, and other stakeholders interested in using Medicaid for services in PSH can learn from some promising program initiatives now under way. This chapter reviewed developments in managed care arrangements in case study sites to include provisions designed to meet the needs of people with complex health needs and cooccurring conditions, including those experiencing chronic homelessness or living in PSH. These include Minnesota's Special Needs Basic Care program and the Louisiana Behavioral Health Partnership.
Experiences with enrolling seniors and persons with disabilities in managed care plans in some other case study sites indicate that the shift to managed care may encounter some setbacks, at least initially if managed care plans and health care provider networks lack experience with people who have a mental illness or other disabilities (with or without co-occurring substance use issues), making it difficult for the plans to offer a sufficient supply of some services or to facilitate continuity of care with trusted service providers. New initiatives are under way to alleviate these difficulties.