Impact of the 1115 behavioral health Medicaid waiver on adult Medicaid beneficiaries in New York State

Abstract

Objective: To evaluate the impact of the Health and Recovery Plan (HARP), a capitated special needs Medicaid managed care product that fully integrates physical and behavioral health delivery systems in New York State. Data Sources: 2013-2019 claims and encounters data on continuously enrolled individuals from the New York State Medicaid data system.

The effects of behavioral health integration in Medicaid managed care on access to mental health and primary care services—Evidence from early adopters

“…A more recent RAND assessment 35 of states' experiences in adopting a behavioral health carve-in model found only three studies that examined the outcomes of the carve-in model with rigorous quasiexperimental designs. 22,36,37 These single-state studies were somewhat inconsistent in their findings, with two studies finding increased behavioral health access with the carve-in and one finding decreased access. Our study differs from these studies in the longer (nearly fouryear) period of post-intervention observations and a relative lack of confounding policies.…”

“…Frank and Garfield's 2007 review of behavioral health carve‐outs in Medicaid and commercial markets was generally favorable, concluding that “[a]lthough not perfect, carve‐outs have been instrumental in addressing long‐standing challenges in utilization, access, and cost of behavioral health care.” 34 Within Medicaid, their review found carve‐outs to be associated with lower utilization of psychiatric inpatient services but did not find strong associations with outpatient utilization or quality. A more recent RAND assessment 35 of states' experiences in adopting a behavioral health carve‐in model found only three studies that examined the outcomes of the carve‐in model with rigorous quasi‐experimental designs 22,36,37 . These single‐state studies were somewhat inconsistent in their findings, with two studies finding increased behavioral health access with the carve‐in and one finding decreased access.…”