The Journal of Behavioral Health Services & Research

, Volume 26, Issue 4, pp 400–415

Florida's medicaid mental health carve-out: Lessons from the first years of implementation


DOI: 10.1007/BF02287301

Cite this article as:
Ridgely, M.S., Giard, J. & Shern, D. The Journal of Behavioral Health Services & Research (1999) 26: 400. doi:10.1007/BF02287301


Florida, like many other states, has embarked on an experiment with managed mental health care for Medicaid enrollees. Under a 1915(b) waiver, the state's Medicaid agency began a mental health carve-out demonstration in March 1996 in the Tampa Bay area. This qualitative case study seeks to ascertain the impact of the carve-out (and, by comparison, HMO arrangements) on the public mental health sector. Findings suggest that the carve-out demonstration has succeeded in creating a fully integrated mental health delivery system with financial and administrative mechanisms that support a shared clinical model. However, other findings raise concerns about the HMO model in terms of stability, access to care, efficiency, and more generally about the shifting of risk and public responsibility “downstream” to private organizations without sufficient governmental oversight. These findings may offer guidance for other states implementing major managed care policy initiatives for disabled Medicaid enrollees.

Copyright information

© Association of Behavioral Healthcare Management 1999

Authors and Affiliations

  • M. Susan Ridgely
    • 1
  • Julienne Giard
    • 2
  • David Shern
    • 2
  1. 1.RAND HealthSanta Monica
  2. 2.the Louis de la Parte Florida Mental Health InstituteUniversity of South FloridaTampa

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