Abstract
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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
General Accounting Office:Medicaid Managed Care: Challenge of Holding Plans Accountable Requires Greater State Effort. GAO/HEHS-97-86. Washington, DC: Government Printing Office, 1997.
Florida Senate:A Review of Publicly Funded Managed Behavioral Health Care in Florida: Report of the Staff of Senate Committees on Health Care; Children, Family and Seniors; Banking and Insurance; and Ways and Means, December 1996.
Health Care Financing Administration:Medicaid Managed Care Enrollment Report: Summary Statistics as of June 30, 1998. Baltimore, MD: Health Care Financing Administration.
Gold M, Sparer M, Chu K: Medicaid managed care: Lessons from five states.Health Affairs 1996; 15:153–179.
Fraser I, Chait E, Brach C: Promoting choice: Lessons from managed Medicaid.Health Affairs 1998; 17:165–173.
McCall N: Lessons from Arizona's Medicaid managed care program.Health Affairs 1997; 16:194–199.
Sturm R: Tracking Changes in Behavioral Health Services: How Have Carve-Outs Changed Care?Journal of Behavioral Health Services & Research 1999; 26:359–370.
Gold M, Aizer A, Salganicoff A:Managed Care and Low Income Populations: A Case Study of Managed Care in Florida. Kaiser Family Foundation and Commonwealth Fund Managed Care and Low Income Populations Project, 1997.
Goldman HH, Morrissey JP, Ridgely MS: Evaluating the Robert Wood Johnson Foundation Program on Chronic Mental Illness.Milbank Quarterly 1994; 72:37–47.
Orwin R, Goldman HH, Sonnefeld L, et al.: Alcohol and drug abuse treatment of homeless persons: Results of the NIAAA Community Demonstration Program.Journal of Health Care for the Poor and Underserved 1994; 5:326–352.
Ridgely MS, Fossett JA, Shern D:Managed Behavioral Health Care: Creating a Classification Scheme to Describe Critical Elements of Public Sector Programs. Tampa, FL: Louis de la Parte Florida Mental Health Institute, 1999.
Silverman M, Ricci E, Gunter M: Strategies for increasing the rigor of qualitative methods in evaluation of health care programs.Evaluation Review 1990; 14:57–74.
Maloy KA, Silver K, Darnell J, et al.:Results of a Multi-Site Study of Mandatory Medicaid Managed Care Enrollment Systems: Implications for Policy and Practice. Washington, DC: Center for Health Policy Research, George Washington University, March, 1999.
Rosenbaum S, et al.:Negotiating the New Health System: Nationwide Study of Medicaid Managed Care Contracts. Second ed. Executive Summary. Washington, DC: George Washington University Medical Center, Center for Health Policy Research, 1998. Retrieved June 8, 1998, from the World Wide Web at http://www.chcs.org.
Shern D, Robinson P:Evaluation of Florida's Prepaid Mental Health Plan: Year 2 Report to the Agency for Health Care Administration. Tampa, FL: Louis de la Parte Florida Mental Health Institute, 1999.
Robinson J: Use and abuse of the medical loss ratio to measure health plan performance.Health Affairs 1997; 16:176–187.
Ridgely MS, Goldman HH: Putting the “failure” of national health care reform in perspective: Mental health benefits and the “benefit” of incrementalism.Saint Louis University Law Review 1996; 40:397–425.
Mechanic D, Schlesinger M, McAlpine D: Management of mental health and substance abuse services: State of the art and early results.Milbank Quarterly 1995; 73:19–55.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ridgely, M.S., Giard, J. & Shern, D. Florida's medicaid mental health carve-out: Lessons from the first years of implementation. The Journal of Behavioral Health Services & Research 26, 400–415 (1999). https://doi.org/10.1007/BF02287301
Issue Date:
DOI: https://doi.org/10.1007/BF02287301