Using Medicaid to Support Working Age Adults with Serious Mental Illnesses in the Community: A Handbook. APPENDIX C: Profiles of States that Operate Managed Mental Health Service Delivery Systems under 1915(b) and 1115 Health Care Demonstration Waiver Programs

01/24/2005

Profiles of 1915(b) Waiver Programs for Persons with Mental Illness
State In operation since 1915(b) Authority Service Area Beneficiaries Served Services Contractor Type
b(1) b(2) b(3) b(4)
California (Medical Specialty Mental Health Services Consolidation)
(Selective contracting only; not a capitated managed care program)
(Operated by California Department of Mental Health through an interagency agreement with the Department of Health Services, the state Medicaid agency).
1995       X Statewide except San Mateo and Solano Counties (San Mateo and Solano Counties are served under other waiver programs) All beneficiary groups (adults and children)
  • Psychiatric Inpatient
  • Psychiatrist
  • Psychologist
  • Targeted case management
  • Rehabilitative services
    • Day rehabilitation
    • Day treatment intensive
    • Adult residential treatment
    • Crisis intervention
    • Crisis stabilization
    • Crisis residential
    • Mental health out patient services
County mental health plan
Colorado (Medicaid Mental Health Capitation and Managed Care Program)
(Operated by state mental health agency through an interagency agreement with the state Medicaid agency).
1995 X   X X Statewide (since 1998) All Medicaid beneficiaries (children and adults)
  • IMD (65 and over)
  • Under 21 psychiatric hospital
  • Case management
  • Emergency
  • Inpatient hospital
  • Medication management
  • Outpatient mental health
  • Physician
  • Psychosocial rehabilitation
  • §1915(b)(3) services:
    • Home-based service for children and adolescents*
    • Intensive case management*
    • Residential services*
    • School-based services*
    • Vocational services*
Mental Health Assessment and Services Agencies (community mental health centers, consortia of centers and/or partnership of one or more centers and private behavioral health organization)
Florida
(Previously the "Prepaid Mental Health Plan"; now combined with the Medicaid Managed Care Waiver)
1996 X     X Prepaid Mental Health Providers operate in two regions. All major eligibility groups (adults and children) except dual eligible, medicaly needy, nursing home/ ICF/MR residents and certain others
  • Psychiatric outpatient
  • Emergency services
  • Day treatment
  • Rehabilitative services
  • Targeted case management
  • Counseling and therapy
  • Others (e.g., in home therapy and rehabilitation for children
Partnership between community mental health providers and private managed care company
Iowa
(Iowa Plan for Behavioral Health)
(Replaced separate mental health and substance abuse managed care plans
1999 X   X X Statewide All major eligibility groups (adults and children) except persons over age 65, dual eligibles, medically needy with a cash spend down and certain others.
  • Inpatient mental health
  • Outpatient mental health (rehabilitative services)
  • Targeted case management
  • Home health
  • Inpatient and outpatient substance abuse services
  • §1915(b)(3) services:
    • Intensive psychiatric rehabilitation
    • Assertive Community Treatment
    • Community support services
    • Substance abuse treatment in 24-hour setting
Single private behavioral health managed care organization
Michigan (Prepaid specialty mental health and substance abuse services and supports for persons with developmental disabilities)
1915(b)/(c) combination waiver
1998 X   X X Statewide All beneficiary groups (adults and children) excluding ICF/MR residents and children enrolled in specialized 1915(c) waiver program
  • Targeted case management
  • Emergency services
  • Inpatient mental health
  • Mental health rehabilitation
  • Mental health residential
  • Mental health support
  • Mental health clinic
  • Partial hospitalization
  • Personal care
  • Transportation
  • Substance abuse services
  • Specialty services and supports for persons with developmental disabilities
  • 1915(b)(3) services:
    • Community living supports
    • Direct Prevention Service Models
    • Extended observation beds
    • Family skills development
    • Housing assistance
    • Peer-delivered services
    • Respite services
    • Skill building assistance
    • Supported employment services
Community mental health services programs (county-based entities that serve MH/DD/SA population)
New Mexico
(Salud!)
(Salud! operates under a 1915(b) waiver and spans the full range of health services. State plans to breakout behavioral health services into spearate plan in 2005.)
1997 X     X Statewide All child and adult beneficiary groups, excluding dual eligibles, nursing facility and ICF/MR residents, Native Americans and certain other beneficiaries
  • Inpatient Mental Health
  • Inpatient Substance Abuse
  • Outpatient Mental Health
  • Outpatient Substance Abuse
Health MCOs that are in turn required to subcontract for behavioral health services through community programs
North Carolina
(Piedmont Cardinal Health Plan)
1915(b)/(c) combination waiver. 1915(c) waiver serves children and adults with developmental disabilities
Expected state date:
April 2005
      X Five county region Children and adults with some exceptions
  • Inpatient hospital
  • High risk behavior intervention
  • ACT
  • Case management
  • Outpatient services
  • Community-based services
Local management entity
Pennsylvania
(Health Choices)
(MH services are included in Health Choices but carved out)
1997 X X X X Various Pennsylvania counties (about 60% of Medicaid eligible population) All beneficiary groups except persons in nursing facilities on ICFs/MR
  • Inpatient hospital
  • Targeted case management
  • Crisis intervention
  • Psychiatric outpatient and partial hospitalization
  • Mental health residential
  • Drug and alcohol services
  • Rehabilitation
  • Case Management
  • Private behavioral health managed care organizations
  • County-operated organizations
Texas (Northstar) 1999 X X   X Seven counties in Dallas service area Most beneficiary groups (children and adults) except for medically needy and institutionalized persons
  • Inpatient mental health and substance abuse
  • Mental health outpatient and rehabilitative services
  • Targeted case management
  • Assertive community treatment
  • Crisis
  • Dual diagnosis services
  • Various substance abuse services
Single private behavioral health managed care organization
Utah
(Prepaid Mental Health Program)
1991 X   X X Nine of state's 10 mental health service areas (very rural service area excluded) All types of beneficiaries5
(children and adults)
  • Crisis
  • MH inpatient
  • MH Outpatient
  • Transportation
  • Medication Management
  • Skills Development
  • Targeted case management
  • MH Rehabilitation
  • §1915(b)(3) services:
    • Psych-education Services (educational and vocational services that contribute to accelerating rehabilitation
    • Personal care
    • Respite (children)
    • Supportive Living
    • Therapeutic Home Services
Nine Community mental health centers
Washington
(Integrated Community Mental Health Program)
1993 X   X X Statewide All beneficiary groups (children and adults) except dual eligibiles, residents of state owned institutions and certain other groups.
  • Emergency mental health services.
  • Inpatient hospital
  • Psychologist
  • Case management
  • Outpatient (rehabiltiative services)
    • Crisis intervention
    • Stabilization
    • Medication Management
    • Individual and group therapy
    • Adult day treatment
    • Family therapy
    • Other (including service for children)
14 Regional Support Networks (county-based entities)

 

Profiles of 1115 Demonstrations with Managed Care Behavioral Health Carve-Outs
State Scope Covered Groups Services Contractors
Arizona
(Behavioral Health Services, including mental health and substance abuse services)
(Administered by AZ Department of Health Services, Division of Behavioral Health Services)
All mental health and substance abuse services, including services for individuals with serious mental illnesses and services for "general mental health crisis"). In October 2002, there were 52,000 individuals enrolled for services. All child and adult eligibility groups except for certain special needs children
  • Treatment
  • Rehabilitation
  • Medical Services (including medications for treatment of mental illness)
  • Supportive Services, including:
    • Case management
    • Personal care
    • Peer Support
    • Supported housing
    • Respite care
  • Crisis intervention
  • Inpatient
  • Residential Services
  • Behavioral health day programs
  • Prevention services
Regional Behavioral Health Authorities (8 in total, including 3 tribal RBHAs through intergovernmental agreements)
Non-tribal RBHAs are private sector companies or non-profit agencies that serve specified areas
Hawaii (Behavioral Health Managed Care Plan -- BMHCP) This carve-out is part of the Hawaii QUEST 1115 Demonstration. Individuals determined to have a serious mental illness are enrolled in the carve-out on a voluntary basis. BMHCP also serves persons with co-occurring substance-abuse. The carve-out offers a wider array of services than are furnished by standard health care MCOs. Adult eligibility groups only; children are not included
  • Crisis
  • Inpatient/outpatient mental health
  • Rehabilitation
  • MH Residential
  • MH Support
  • Pharmacy
  • Inpatient/outpatient substance abuse
  • Detoxification
  • Residential substance abuse services
  • Opiate treatment
Private managed care organization/subcontract to private behavioral health organization
Massachusetts
(Massachusetts Behavioral Health Partnership - MBHP)
MBHP is part of the Mass Health 1115 Demonstration program. Under Mass Health, individuals may elect to receive services through a comprehensive MCO. Such MCOs are required to furnish mental health services. Alternatively, a person may select PCCM model. Individuals who elect this option are automatically enrolled in MBHP to receive mental health services. SSI beneficiaries are enrolled to PCCM option All child and adult beneficiaries except dual eligibles, nursing facility residents and persons enrolled in a comprehensive benefits MCO health plan.
  • Crisis
  • Detoxification
  • Inpatient/outpatient mental health services
  • Inpatient/outpatient substance abuse services;
  • MH Residential
  • Community Support
  • PACT
  • Opiate treatment
  • Outpatient day programs
  • Residential substance abuse treatment
Private sector behavioral health managed care organization
Oregon
Oregon Health Plan (Mental Health/Substance Abuse Full Capitation Program)
  All child and adult eligibility groups with some minor exceptions
  • Crisis
  • Inpatient/outpatient mental health services
  • Mental Health Rehabilitation
  • Mental Health Support
  • Outpatient substance abuse
10 mental health organizations, either county-operated public entities or regional authority operated entities
Tennessee
Tenncare (PIHP Mental Health and Substance Abuse Full Capitation Program)
Statewide carve-out; no mental health services are furnished by health care MCOs All child and adult Medicaid eligibility groups plus SCHIP recipients plus expansion populations with some exceptions
  • Crisis
  • Detoxification
  • Inpatient/outpatient mental health services
  • Inpatient/outpatient substance abuse services
  • Mental Health Rehabilitation
  • Mental Health Support
  • Residential substance abuse treatment programs
Private sector behavioral health managed care organizations

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