Using Medicaid to Support Working Age Adults with Serious Mental Illnesses in the Community: A Handbook. CHAPTER 7: ADDITIONAL DIMENSIONS OF USING MEDICAID


This chapter covers several additional topics related to supporting working-age adults with serious mental illnesses in the community. These include community integration of institutionalized persons, consumer-directed services, advance directives, and telemedicine. The chapter also explores topics related to the management of Medicaid services.

Successfully supporting people with serious mental illnesses in the community has many aspects. This chapter explores several of them in the context of their relationship to the Medicaid program. One aspect is the community integration of persons who were institutionalized, which has drawn increased attention in the wake of the U.S. Supreme Court’s landmark 1999 Olmstead decision. Another is consumer-directed services, which has garnered substantial interest at the federal and state levels, and especially among people with disabilities who want more control over their services and supports. Related to consumer-directed services are psychiatric advance directives that enable individuals to specify their preferences about treatment and services in the event they are incapacitated. Yet another aspect is the use of telemedicine to provide services.

The chapter also discusses several topics related to the management of Medicaid services, including interagency agreements between the state Medicaid agency and the state mental health authority, and federal financial participation in the costs of administering Medicaid services.

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