Using Medicaid to Support Working Age Adults with Serious Mental Illnesses in the Community: A Handbook. Endnotes


  1. Cille Kennedy contributed to the preparation of this section.

  2. The 1954 New York State Community Care Act was the first venture by a state to furnish services to individuals with serious mental illnesses in the community. The Act provided that state mental hospital psychiatrists could continue to provide services to individuals who had been discharged from hospitals to the community.

  3. Virginia Mulkern (1995). The Community Support Program: A Model for Federal-State Partnership. Washington DC: Mental Health Policy Resource Center. Early Community Support Program (CSP) efforts included funding for statewide planning and system building in eight states along with funding to establish demonstration programs. In 1980, CSP funding was modified to give states more flexibility in employing funds for infrastructure and system development. By 1984, all 50 states and the District of Columbia had received strategy development grants. Funds also were earmarked to conduct studies of homelessness and demonstration programs to provide services to homeless individuals. Later on, funding was earmarked for demonstrations involving services for older persons, young adults with co-occurring conditions, consumer-operated services, and supportive housing. Funds also supported statewide system improvement, consumer and family support activities, and research demonstrations.

  4. Ibid.

  5. Ibid.

  6. A notable exception is their responsibility to serve individuals committed by the courts.

  7. Adapted from: Bazelon Center for Mental Health Law (2002). An Act Providing for a Right to Mental Health Services and Supports: A Model Law. Washington, DC.

  8. Remarks by Larry Fricks, Director, Office of Consumer Relations, Georgia Department of Human Resources, December 13, 1999 at the White House for the Unveiling of the Surgeon General 's Report on Mental Health.

  9. President’s New Freedom Commission on Mental Health (PNFCMH). Achieving the Promise: Transforming Mental Health Care in America. DHHS Pub. No. SMA-03-3832. Rockville, MD: 2003.

  10. In health, the fundamental precepts of EBP emerged roughly a decade ago. In the United States, the Institute of Medicine has been a central force in promoting the development and implementation of EBPs (see especially, Committee on Quality of Health Care in America (2002). Crossing the Quality Chasm. Institute of Medicine). The Agency for Health Care Policy and Research at the U.S. Department of Health and Human Services has lead responsibility for promoting evidence-based practice in everyday care.

  11. These practices were identified by a consensus panel sponsored by the Robert Wood Johnson Foundation (RWJF). This panel was composed of researchers, families, individuals with mental illnesses and mental health administrators. Funding from RWJF, SAMHSA and other sources is underwriting the preparation of materials by the New Hampshire-Dartmouth Psychiatric Research Center in collaboration with several other organizations in order to facilitate and accelerate the implementation of EBPs by agencies and mental health systems. Implementation “Resource Kits” have been prepared for each practice for use by administrators, program directors, practitioners, individuals with mental illnesses, and families. These toolkits are designed to promote interest in the use of these practices, facilitate their adoption, and provide tools (fidelity measures) to assess if the practice is being used consistently. These kits are located at

  12. Unless otherwise specified, all the descriptions of evidence-based practices summarize materials included in: the 2002 draft toolkits, materials disseminated by the New York State Office of Mental Health via its web site, and the 1999 Surgeon General’s Report on Mental Health.

  13. There are extensive materials concerning ACT that are available from the National Alliance for the Mentally Ill (NAMI), which has been a leading advocate for the expanded availability of ACT nationwide. NAMI employs the acronym PACT (Program for Assertive Community Treatment). NAMI also has exercised leadership in the development of standards for ACT. For more information, go to:

  14. NAMI Issue Spotlight: Employment and Income

  15. PNFCMH (2003), op cit

  16. New York State Office of Mental Health (2002). OMH Introduces “Winds of Change.” Available at

  17. Personal communication: Larry Fricks and Wendy White-Tiegreen, Georgia Department of Human Resources.

  18. The federal and state-federal programs identified in the graphic are not exhaustive. For example, there are additional federal programs that furnish targeted dollars to support homeless individuals and families, including individuals with serious mental illnesses. A complete listing and discussion of federal and state-federal programs that play a role in meeting the needs of individuals (children and adults) with mental illnesses is contained in Major Federal Programs Supporting and Financing Mental Health Care (January 2003), prepared on behalf of the President’s New Freedom Commission on Mental Health, available at

  19. Ibid.

  20. Ibid.

  21. Ibid. See also: Carol Bianco and Susan Milstrey Wells (eds.) (2001). Op. cit.

  22. PNFCMH (2003). Op. cit.

  23. Behavioral health includes mental health and substance abuse services.

  24. Coffey, Mark, King, et al. (2000). National Estimates of Expenditures for Mental Health and Substance Abuse Treatment 1997. Rockville MD: Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services. (SAMSHA Publication SMA-00-3499).

  25. Jeffrey A. Buck (2003). “Medicaid, Health Care Financing Trends, and the Future of State-Based Public Mental Health Services.” Psychiatric Services, Vol. 54. No.7.

  26. Social Security Administration. 2002 Annual Statistical Supplement, Social Security Bulletin.

  27. Frank, R., Goldman, H., & Hogan, M. (2003). Medicaid and Mental Health: Be Careful What You Ask For. Health Affairs 22(1): pp. 101-113.

  28. California Department of Mental Health (1999). Frequently Asked Questions About Systems of Care, Medicare and Medi-Cal.

  29. In particular, states have used the Medicaid home and community-based services (HCBS) waiver program extensively to underwrite home and community services for individuals of all ages with all types of disabilities, except individuals with disabilities due to mental illnesses. For individuals with developmental and other disabilities, states may offer HCBS as an “alternative” to services in a Medicaid-reimbursable institutional setting (nursing facilities or ICFs/MR).

  30. Glenn Stanton, CMS, personal communication.

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