Assessment, Authorization and Access to Medicaid Managed Mental Health Care

Impacts of an Integrated Medicaid Managed Care Program for Adults with Behavioral Health Conditions: The Experience of Illinois

This study assessed the impact of the Integrated Care Program (ICP), a new Medicaid managed care model in Illinois, on health services utilization and costs for adults with behavioral health conditions. Data sources included Medicaid claims, encounter records, and state payment data for 28,127 persons with a behavioral health diagnosis. Difference-in-differences models, in conjunction with propensity score weighting, were used to compare utilization and costs between ICP enrollees and a fee-for-service (FFS) comparison group. The model considered the impact of the SMART Act, which restricted access to care for the comparison group. Before the SMART Act, ICP was associated with 2.8 fewer all-cause primary care visits, 34.6 fewer behavioral health-specific outpatient visits, and 2.5 fewer all-cause inpatient admissions per 100 persons per month, and $228 lower total costs per member per month relative to the FFS group. After the SMART Act, ICP enrollees had increased outpatient and dental services utilization without significantly higher costs. The relative increase in utilization was due primarily to decreased utilization in the restricted FFS group after the SMART Act. By the end of the study period, the ICP group had 13.3 more all-cause primary care visits, 1.5 more emergency department visits, and 1.4 more dental visits per 100 persons per month relative to the FFS program. A fully-capitated, integrated managed care program has the potential to reduce overall Medicaid costs for people with behavioral health conditions without negative effects on service utilization.

Limited English proficient Asian Americans: Threshold language policy and access to mental health treatment

The importance of providing timely, effective mental health services is increasingly recognized worldwide, and language barriers are a formidable obstacle to achieving this objective. Threshold language policy is one response implemented by California and other states within the U.S., in accordance with Title VI of the Civil Rights Act of 1964, which prohibits discrimination on the basis of race, color, and national origin in programs receiving federal funding. This policy mandates language assistance services for Medicaid enrollees whose primary language is other than English once their population size reaches a designated level. Medicaid is the federal-state-funded health insurance program for specific classifications of low-income Americans. This study evaluated the impact of threshold language policy on Vietnamese, Cantonese, Hmong, and Cambodian limited English proficiency persons' use of public mental health services in California. Using random-effects regression on 247 observations, we regressed aggregate Vietnamese, Cantonese, Hmong, and Cambodian Medicaid mental health service penetration rates on an indicator of the threshold language policy's implementation, while controlling for a linear time trend and the effects of non-threshold language assistance programming. Immediately after implementation, threshold language policy requirements were associated with a penetration rate increase among this population. The penetration rate increase became greater after accounting for the impact of concurrent language assistance. However, this increase diminished over time. The findings indicate that, at least in the short run, language assistance measures requiring reasonable accommodations once populations of LEP persons reach a specified size have detectable effects on their mental health service use. These requirements increase the number of mental health consumers, but appear to provide declining benefit over time. California's threshold language policy provides one example of how public or national health systems worldwide may attempt to address the issue of equity of mental health service access for burgeoning immigrant/migrant populations with language assistance needs.

Ethnic Differences in Children's Entry into Public Mental Health Care via Emergency Mental Health Services

For children and youth making a mental health crisis visit, we investigated ethnic disparities in whether the children and youth were currently in treatment or whether this crisis visit was an entry or reentry point into mental health treatment. We gathered Medicaid claims for mental health services provided to 20,110 public-sector clients ages 17 and younger and divided them into foster care and non-foster care subsamples. We then employed logistic regression to analyze our data with sociodemographic and clinical controls. Among children and youth who were not placed in foster care, African Americans, Latinos, and Asian Americans were significantly less likely than Caucasians to have received mental health care during the three months preceding a crisis visit. Disparities among children and youth in foster care were not statistically significant. Ethnic minority children and youth were more likely than Caucasians to use emergency care as an entry or reentry point into the mental health treatment, thereby exhibiting a crisis-oriented pattern of care.