Medicaid Managed Behavioral Health in Rural Areas

Abstract

As of 2000, 21 states had implemented Medicaid managed behavioral health (MMBH) programs for a significant portion of their rural population. It is not clear how MMBH programs may work in rural areas since they are primarily designed to control mental health utilization. In rural areas the challenge is often to enhance service delivery, not to reduce it. MMBH programs may also affect important features of rural delivery systems, including access to care and coordination of primary care and specialty mental health providers. This article describes the implementation of MMBH programs in rural areas based on an inventory of states implementing MMBH programs in rural counties conducted between June 1999 and June 2000. The experience of MMBH programs in rural areas is also described based on case studies conducted in six states. All 21 states included the general Medicaid population (Temporary Assistance for Needy Families); 17 states included special Medicaid populations (adults with serious and persistent mental illness and children with serious emotional disturbances). Slightly less than half the states integrated (carved-in) behavioral health with physical health services in serving the general Medicaid population; only one state integrated these services for the special Medicaid population. Access to mental health care in rural areas had generally not been restricted. MMBH had little impact on the linkage between primary care and mental health. Local Managed Behavioral Health Organizations, formed by public sector entities and providers, played an increasingly important role in the evolution of MMBH.

Medicaid Managed Care for Mental Health Services: The Survival of Safety Net Institutions in Rural Settings

“…In our research, rural clinicians, staff, and clients repeatedly expressed frustration that "nobody is listening to us." In this context, others have observed that that political processes in the development of MMC and other reform policies for mental health services typically address statewide or urban, rather than rural, concerns (Lambert et al, 2003). Our research suggested that people in rural communities perceived themselves as disenfranchised from the development of state policies.…”

Overview Of Publicly Funded Managed Behavioral Health Care

“…In part, this is due to a lack of clarity as to what specifically defines an integrated model and failure to define and reward concrete roles for primary care and mental health providers (Blount, 2003;Lambert et al, 2001).…”

“…A state's success requires full participation from five key stakeholders: (1) state leadership (including all state agencies involved in behavioral health care delivery), (2) managed behavioral health organizations, (3) providers, (4) consumers, and (5) families (Dougherty, 2003). The 2001 report, Medicaid Managed Behavioral Health in Rural Areas, comments about the decisions of Montana, Arkansas, Kentucky, Arizona, and North Carolina to revert to fee-for-service care, ''In the final analysis, they were undone not by their failure to manage care but by their inability to address problems that threatened the stability of their key stakeholders'' (Lambert et al, 2001).…”

“…Access in rural and frontier states can be difficult with or without managed care, but it is possible to increase access in rural states through managed behavioral health care (Lambert, 2001).…”

“…Further, service needs and goals for a state or regional managed behavioral health program may be different for rural states and counties who typically face ongoing service delivery infrastructure and access challenges (Lambert, Gale, Bird, & Hartley, 2003).…”