Outcomes for Rural Medicaid Clients with Severe Mental Illness in Fee for Service versus Managed Care

Abstract

This study compared outcomes for rural Medicaid clients with severe mental illness in fee for service versus managed care programs. Interviews were conducted with 305 Medicaid clients in rural Oregon (166 in fee for service and 139 in managed care). Logistic and multivariate regression analyses were used to examine client satisfaction, safety, symptoms, functioning, and family satisfaction in the fee for service versus managed care groups. There was no evidence that conversion of the Medicaid mental health system from fee for service to managed care led to changes in outcomes for rural clients with severe mental illness.

Managed Behavioral Health Care Carve-Outs: Past Performance and Future Prospects

“…Similarly, Cuffel et al (18) explicitly compare costs for general medical care before and after a carve-out and find lower overall health care spending after the carve-out. Studies do note, however, that there is evidence of cost shifting to some behavioral health services not included in carve-out contracts, such as prescription drugs 5 (4,10,12) or child welfare services (41).…”

“…However, a larger number of studies of general behavioral health services, depression care, or serious mental illness or schizophrenia find no change in quality following carve-out implementation. These studies use measures ranging from readmission rates (7,49) to satisfaction (5, 13) to symptoms and functioning levels (5,17).…”

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

“…Previous studies by have examined the general impact of MMC (The Lewin Group, 2009; Marton, Yelowitz, Talbert, 2014; Duggan, Hayford, 2013; Bindman, Chattopadhyay, Osmond, Huen, Bacchetti, 2004), and several have focused on beneficiaries with behavioral health conditions (Hutchinson, Foster, 2003; Callahan, Shepard, Beinecke, Larson, Cavanaugh, 1995; Bianconi, Mahler, McFarland, 2006; Bouchery, Harwood, 2003; Leff, et al, 2005; Masland, Snowden, Wallace, 2007), but the findings have been mixed. While the review from Kronick, Bella, and Gilmer (2009) of MMC programs from the 1990s and early 2000s showed potential for cost savings, an analysis of MMC mandates and state Medicaid expenditures during a similar timeframe reported that shifting from FFS to MMC did not reduce Medicaid spending in most states (Marton, Yelowitz, & Talbert, 2014).…”

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

“…The focus on clinical integration and payment reforms in ACA drove more states to move toward comprehensive "carve-in," or integrated Medicaid managed Care (MMC), to finance and administer different types of services within a single managed care plan. 4 A few early studies reported negligible differences between MMC and fee-for-service (FFS) in access and utilization of health services for people with behavioral health conditions, 5,6 while an evaluation of Nebraska's MMC showed a significant decline in inpatient mental health treatment. 7 Based on previous research, adults with behavioral health conditions account for almost 50% of Medicaid beneficiaries and are one of the most medically needy and high-cost populations.…”