Assessment, Authorization and Access to Medicaid Managed Mental Health Care

  • Mary C. Masland
  • Lonnie R. Snowden
  • Neal  T. Wallace


Examined were effects on access of managed care assessment and authorization processes in California’s 57 county mental health plans. Primary data on managed care implementation were collected from surveys of county plan administrators; secondary data were from Medicaid claims and enrollment files. Using multivariate fixed effects regression, we found that following implementation of managed care, greater access occurred in county plans where assessments and treatment were performed by the same clinician, and where service authorizations were made more rapidly. Lower access occurred in county plans where treating clinicians authorized services themselves. Results confirm the significant effects of managed care processes on outcomes and highlight the importance of system capacity.


Managed care Access Medicaid System capacity 


  1. Bloom, J. R., Hu, T. W., Wallace, N., Cuffel, B., Hausman, J., Sheu, M. L., & Scheffler, R. (2002). Mental health costs and access under alternative capitation systems in Colorado. Health Services Research, 37, 315–340.PubMedCrossRefGoogle Scholar
  2. Bloom, J. R., Toerber, G., Hausman, J. W., Cuffel, B., & Barrett, T. J. (1994). An analysis of capitation for mental health services. Policy Studies Journal, 22(4), 681–690.CrossRefGoogle Scholar
  3. Brach, C., Sanches, L., Young, D., Rogers, J., Harvey, H., & McLemore, T. (2000). Wrestling with typology: Penetrating the black box of managed care by focusing on health care system characteristics. Medical Care Research and Review, 57(2), 93–115.PubMedCrossRefGoogle Scholar
  4. Callahan, N., & Yamamoto, A. (1999). California’s Medi-Cal Mental Health Service Delivery System: Assuring Access, Quality and Cost-Effectiveness. Independent Assessment for HCFA 1915b Waiver Prepared for the State of California, Department of Mental Health. Davis: I.D.E.A. Consulting.Google Scholar
  5. Catalano, R. A., Libby, A. M., Snowden, L. R., & Cuellar, A. E. (2000). The effect of capitated financing on mental health services for children and youth: The Colorado experience. American Journal of Public Health, 90, 1861–1865.PubMedCrossRefGoogle Scholar
  6. CDMH(1994). Medi-Cal Managed Mental Health Care. June 1, 1994. Sacramento, Ca: Department of Mental Health.Google Scholar
  7. CDMH(2000). Data Dictionary for the Cost Reporting Data Collection (CRDC) System. Provided to the research team by Kathy Styc, Chief, Division of Statistics and Data Analysis, June 18, 2000. Sacramento: Department of Mental Health.Google Scholar
  8. Christianson, J. B., Manning, W. G., Lurie, N., Stoner, T. J., Gray, D. Z., Popkin, M., & Marriott, S. (1995). Utah’s prepaid mental health plan: The first year. Health Affairs, 14, 160–172.PubMedCrossRefGoogle Scholar
  9. Cuffel, B. J., Bloom, J. R., Wallace, N., Hausman, J. W., & Hu, T. W. (2002). Two-year outcomes of fee-for-service and capitated Medicaid programs for people with severe mental illness. Health Services Research, 37, 341–359.PubMedCrossRefGoogle Scholar
  10. Dickey, B., Normand, S. T., Hermann, R., Eisen, S. V., Cortes, D. E., Cleary, P. D., & Ware, N. (2003). Guideline recommendations for treatment of schizophrenia, the impact of managed care. Archives of General Psychiatry, 60(4), 340–348.PubMedCrossRefGoogle Scholar
  11. Donabedian, A. (1980). Explorations in quality assessment and monitoring: The definition of quality and approaches to its assessment (Vol. 1). Ann Arbor, MI: Health Administration Press.Google Scholar
  12. Frank, R. G., & McGuire, T. G. (1997). Savings from a Medicaid carve-out for mental health and substance abuse treatment in managed care: The Massachusetts Medicaid experience. Psychiatric Services, 48, 1147–1152.PubMedGoogle Scholar
  13. Landon, B. E., Wilson, I. B., & Cleary, P. E. (1998). Conceptual model of the effects of health care organizations on the quality of health care. Journal of the American Medical Association, 279(17), 1377–1382.PubMedCrossRefGoogle Scholar
  14. Leff, H. S., Malkern, V., Lieberman, M., & Rabb B. (1994). The effects of capitation on service access, accuracy, and appropriateness. Administration and Policy in Mental Health, 21(3), 141–160.CrossRefGoogle Scholar
  15. Manning, W. G., Liu, C. F., Stoner, T. J., Gray, D. Z., Lurie, N., Popkin, M., & Christianson, J. B. (1999). Outcomes for Medicaid beneficiaries with schizophrenia under a prepaid mental health carve-out. Journal of Behavioral Health Services Research, 26, 442–450.PubMedCrossRefGoogle Scholar
  16. Masland, M.C. (1997). Local variation in response to decentralization of authority in California’s public mental health system. Dissertation for the degree of Ph.D. in Health Services and Policy Analysis. Berkeley: University of California.Google Scholar
  17. Masland, M. C., Piccagli, G., Cuffel, B.J., & Snowden, L. (1996). Planning and implementation of capitated mental health programs in the public sector. Evaluation and Program Planning, 19(3), 253–262.CrossRefGoogle Scholar
  18. Masland, M. C., Snowden, L. R., & Wallace, N. T. (2007). Plan structure and access to Medicaid managed mental health in California. Berkeley: University of California, Manuscript submitted for publication.Google Scholar
  19. Mechanic, D. (1999). The state of behavioral health in managed care. The American Journal of Managed Care, 5, SP17–SP21.Google Scholar
  20. Mechanic, D. (2003). Managing behavioral health in Medicaid. New England Journal of Medicine, 348, 1914–1916.PubMedCrossRefGoogle Scholar
  21. Meredith, L. S., Rubenstein, L. V., Rost, K., Ford, D. E., Gordon, N., Nutting, P., Camp, P., & Wells, K. B. (1999). Treating depression in staff-model versus network-model managed care organizations. Journal of General Internal Medicine, 14, 39–48.PubMedCrossRefGoogle Scholar
  22. Meredith, L. S., Sturm, R., Camp, P., & Wells, K. (2001). Effects of cost-containment strategies within managed care on continuity of the relationship between patients with depression and their primary care providers. Medical Care, 39, 1075–1085.PubMedCrossRefGoogle Scholar
  23. Pincus, H. A., Zarin, D. A., & West, J.C. (1996). Peering into the Black Box: Measuring outcomes of managed care. Archives of General Psychiatry, 53, 870–877.PubMedGoogle Scholar
  24. Ray, W. A., Daugherty, J. R., & Meador, K. G. (2003). Effect of a mental health “carve-out” program on the continuity of antipsychotic therapy. New England Journal of Medicine, 348, 1885–1894.PubMedCrossRefGoogle Scholar
  25. Ridgely, M. S., Giard, J., & Shern, D. (1999). Florida’s Medicaid mental health carve-out: Lessons from the first years of implementation. Journal of Behavioral Health Services and Research, 26(4), 400–415.PubMedCrossRefGoogle Scholar
  26. Ridgely, M. S., Girard, J., Shern, D., Mulkern, V., & Burnam, M. A. (2002a). An instrument to characterize elements of public sector programs. Health Services Research, 37(4), 1105–1123.PubMedCrossRefGoogle Scholar
  27. Ridgely, M. S., Mulkern, V., Girard, J., & Shern, D. (2002b). Critical elements of public sector managed behavioral health programs for severe mental illness in 5 states. Psychiatric Services, 53(4), 397–399.PubMedCrossRefGoogle Scholar
  28. Rosenthall, M. B., Minden, S. L., Kimmel, W. A., Henderson, M. J., & Manderscheid, R. W. (2004). Chapter 4: Toward a typology of behavioral health care: Featuring purchasing, partitioning, and risk transfer. In R. W. Manderschied & M. J. Henderson (Eds.), Mental Health, United States, 2002, DHHS Pub. No. (SMA) 3938. Rockville: Substance Abuse and Mental Health Services Administration.Google Scholar
  29. Sabin, J. E., & Daniels, N. (1999). Public sector managed behavioral health care: II. Contracting for Medicaid services: The Massachusetts experience. Psychiatric Services, 50, 39–41.PubMedGoogle Scholar
  30. Shern, D. L., Donahue, S. A., Felton, C., Joseph, G. R., & Brier, N. (1995). Partial capitation versus fee-for-service in mental health care. Health Affairs, 14, 208–219.PubMedCrossRefGoogle Scholar
  31. Stoner, T., Manning, W., Christianson, J., Gray, D. Z., & Marriott, S. (1997). Expenditures for mental health services in the Utah prepaid mental health plan. Health Care Financing Review, 18(3), 73–93.PubMedGoogle Scholar
  32. Stroup, T. S., & Dorwart, R A. (1995). Impact of managed mental health program on Medicaid recipients with severe mental illness. Psychiatric Services, 46, 885–889.PubMedGoogle Scholar
  33. Sturm, R. (1997). How expensive is unlimited mental health coverage under managed care? Journal of the American Medical Association, 278, 1533–1537.PubMedCrossRefGoogle Scholar
  34. Tye, S., Phillips, K. A., Kiang, S. Y., & Haas, J. S. (2004). Moving beyond the typologies of managed care: The example of health plan predictors of screening mammography. Health Services Research, 39(1), 179–206.PubMedCrossRefGoogle Scholar
  35. Wallace, N. T., Bloom, J. R., Hu, T. W., & Libby, A. M. (2005). Medication treatment patterns for adults with schizophrenia in Medicaid mental health managed care in Colorado. Psychiatric Services, 56, 1402–1408.PubMedCrossRefGoogle Scholar
  36. Weiner, J. P., & de Lissovoy, G. (1993). A taxonomy for managed care and health insurance plans. Journal of Health Politics, Policy, and Law, 18, 75–103.Google Scholar
  37. Wells, K. B., Schoenbaum, M., Unutzer, J., Lagomasino, I. T., & Rubenstein, L. V. (1999). Quality of care for primary care patients with depression in managed care. Archives of Family Medicine, 8, 529–535.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Mary C. Masland
    • 1
  • Lonnie R. Snowden
    • 1
    • 2
  • Neal  T. Wallace
    • 3
  1. 1.Department of Psychology, Center for Mental Health Services Research, Institute of Personality and Social ResearchUniversity of CaliforniaBerkeleyUSA
  2. 2.School of Social WorkUniversity of CaliforniaBerkeleyUSA
  3. 3.Hatfield School of GovernmentPortland State UniversityPortlandUSA

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