In Louisiana, the state has selected a MCO that is responsible for administering its new behavioral health carve-out. Included in covered services are services to people in PSH or eligible for PSH. Negotiations are under way on the level of funding that will be provided.
In California, for more than a decade most Medicaid-reimbursed mental health services, including psychiatric hospitalizations and community-based mental health services, have been administered through county-level managed care arrangements. California is now moving to require nearly all disabled Medicaid beneficiaries in the states urban counties to enroll in Medicaid managed care plans for their medical care, under the terms of a recently approved waiver.
In Illinois, the state legislature enacted a Medicaid reform law in early 2011, mandating that 50 percent of all Medicaid recipients in the state be in coordinated care by January 2015. The law provides authority for the states Department of Healthcare and Family Services (DHFS) to design approaches to coordinated care that include primary care, behavioral health services, hospital services, rehabilitation, and long-term care services. In June 2011, DHFS released a summary of key policy issues related to care coordination, with a request for stakeholder comments.42
Plans for coordinated care in Illinois are likely to include a range of innovative approaches to delivery systems and payments, in addition to traditional fully-capitated managed care arrangements. DHFS has asked for stakeholder input regarding special arrangements to accommodate entities that want to provide coordinated care to particularly expensive or otherwise difficult clients and is considering sponsoring demonstration projects to launch care coordination. In conjunction with the opportunities created by the Illinois Medicaid reform law, the Michael Reese Health Trust has provided a grant to support an intensive planning effort involving HHO and the AIDS Foundation of Chicago. Their work is intended to lay the groundwork for creating an Accountable Care Organization (ACO) for a very vulnerable target population of people who are (or will be) enrolled in Medicaid.