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Assessment, Authorization and Access to Medicaid Managed Mental Health Care

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Administration and Policy in Mental Health and Mental Health Services Research Aims and scope Submit manuscript

Abstract

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.

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Notes

  1. In 1991–92, 170,974 clients were served statewide in the county Short Doyle system while 172,128 clients were served in the Medi-Cal fee-for-service system (CDMH 1994).

  2. Alameda, Kern, Placer, Riverside and San Joaquin Counties.

  3. Alpine, El Dorado, Lake, Los Angeles, Sacramento, Santa Clara, Santa Cruz and Tuolomne Counties.

  4. San Diego County.

  5. Three of the state’s 57 county mental health plans did not transition typically to managed care because they were already acting as special demonstration sites for Medicaid reimbursement initiatives, or they were too small and opted to have their Medicaid population served by neighboring counties.

  6. CalWorks is California’s Temporary Assistance for Needy Families program providing cash aid and services to eligible needy families. It is operated locally by county welfare departments.

  7. The SAS TSCSREG (Time Series Cross Section Regression) procedure was used to estimate the model.

  8. These results are for all enrollees. Separate models were also run for disabled enrollees (proxy measure for the SMI population) and non-disabled enrollees (proxy measure for the non-SMI population) to observe any difference in the effect of managed care procedures on access between the two populations. Results were very similar for both groups and for the entire group as a whole. Therefore, only results from the entire group are shown here.

  9. 0.216/100 × 49,102 adult Medi-Cal enrollees on average in each county = 106 enrollees.

  10. −0.1438/100 × 49,102 adult Medi-Cal enrollees on average in each county = −71 enrollees.

  11. −0.419/100 × 49,102 adult Medi-Cal enrollees on average in each county = −206 enrollees.

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Authors and Affiliations

  1. Department of Psychology, Center for Mental Health Services Research, Institute of Personality and Social Research, University of California, 2140 Shattuck Ave, #409, Berkeley, CA, 94720-1414, USA

    Mary C. Masland & Lonnie R. Snowden

  2. School of Social Work, University of California, Berkeley, USA

    Lonnie R. Snowden

  3. Hatfield School of Government, Portland State University, Portland, OR, USA

    Neal T. Wallace

Authors
  1. Mary C. Masland
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  2. Lonnie R. Snowden
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  3. Neal T. Wallace
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Correspondence to Mary C. Masland.

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Masland, M.C., Snowden, L.R. & Wallace, N.T. Assessment, Authorization and Access to Medicaid Managed Mental Health Care. Adm Policy Ment Health 34, 548–562 (2007). https://doi.org/10.1007/s10488-007-0138-7

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  • DOI: https://doi.org/10.1007/s10488-007-0138-7

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