Abstract
Despite its widespread adoption, little is known about the effect of Medicaid managed care (MMC) on children using mental health services. To assess the state of current research, we reviewed the literature on MMC and synthesized findings regarding access to care, expenditures, utilization, cost-shifting, and quality of care. A literature search was conducted and updated in November 2001. Studies were included if they involved evaluations of MMC, included children with mental health or substance abuse disorders, and had a non-MMC comparison group. Eight studies were included in the review. Most involved carve-outs and capitation. All of the studies that measured cost and service use showed decreases in total costs, inpatient care costs, and inpatient service use. These changes were frequently accompanied by increases in outpatient care. Some evidence suggests that MMC increased access to care for those with less serious conditions. There was no convincing evidence of cost-shifting from mental to physical health or other public agencies. Finally, no study directly measured health outcomes or quality of care. By reducing service use in inpatient settings, MMC has the potential to reduce children's mental health expenditures. The available research provides virtually no evidence on quality of care.
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REFERENCES
Agency for Healthcare Research and Quality. (2001). Child health toolbox: Measuring performance in child health programs. Measuring services for children with special health care needs, March 2001. Retrieved June 7, 2001, from http://www.ahrq.gov/chtoolbx/cshcn.htm
Bailit, M. H., & Burgess, L. L. (1999). Competing interests: Public-sector managed behavioral health care. Health Affairs, 18, 112-115.
Boland, P. (1996). The capitation sourcebook—A practical guide to managing at-risk arrangements. Berkley, CA: Boland Healthcare.
Burns, B. J. (1999). A call for a mental health services research agenda for youth with serious emotional disturbance. Mental Health Services Research, 1, 5-20.
Burns, B. J., Teagle, S. E., Schwartz, M., Gold, A., & Holtzman, A. (1999). Managed behavioral health care: A Medicaid carve-out for youth. Health Affairs, 18, 214-225.
Burns, B. J., Thompson, J. W., & Goldman, H. H. (1993). Initial treatment decisions by level of care for youth in the CHAMPUS Tidewater Demonstration. Administration and Policy in Mental Health, 76-83.
Callahan, J. J., Shepard, D. S., Beinecke, R. H., Larson, M. J., & Cavanaugh, D. (1995). Mental health/substance abuse treatment in managed care: The Massachusetts Medicaid experience. Health Affairs, 14, 173-184.
Catalano, R., Libby, A., Snowden, L., & 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.
Christianson, J. B., Lurie, N., Finch, M., Moscovice, I. S., & Hartley, D. (1995). Use of community-based mental health programs by HMOs: Evidence from a Medicaid demonstration. American Journal of Public Health, 82, 790-796.
Cuellar, A. E., Libby, A. M., & Snowden, L. R. (2001). How capitated mental health care affects utilization by youth in the juvenile justice and child welfare systems. Mental Health Services Research, 3, 61-72.
Deal, L. W., Shiono, P. H., & Behrman, R. E. (1998). Children and managed health care: Analysis and recommendations. The Future of Children, 8, 4-24.
Dickey, B., Normand, S. L., Norton, E. C., Rupp, A., & Azeni, H. (2001). Managed care and children's behavioral health services: The Massachusetts experience. Psychiatric Services, 52, 183-188.
Draper, D., CyBulski, K., & Ciemnecki, A. (2001). How are persons with mental illness faring under TennCare? In Perspectives on Medicaid managed care. Washington, DC: Mathematica Policy Research.
Findlay, S. (1999). Managed behavioral health care in 1999: An industry at a crossroads. Employers and states are still eager to buy managed mental health care, while the industry experiences more growing pains. Health Affairs, 18, 116-124.
Foster, E. M., & Bickman, L. (2000). Refining the costs analyses of the Fort Bragg evaluation: The impact of cost offset and cost-shifting. Mental Health Services Research, 2, 13-25.
Foster, E. M., & Connor, T. (2002, March). The full costs of the system of care: Cost-shifting across child-serving sectors. Paper presented at 15th Annual Research Conference, A System of Care for Children's Mental Health: Expanding the Research Base, Tampa, FL.
Fox, P. D., & Neuschler, E. (1993). Managed care in Medicare and Medicaid. In P. Boland (Ed.), Making managed healthcare work—a practical guide to strategies and solutions. Gaithersburg, MD: Aspen Publishers.
Frank, R. G., Huskamp, H. A., McGuire, T. G., & Newhouse, J. P. (1996). Some economics of mental health 'carve-outs.' Archives of General Psychiatry, 53, 933-937.
Goldman, W., McCulloch, J., & Sturn, R. (1998). Costs and use of mental heath services before and after managed care. Health Affairs, 17, 40-52.
Hanson, K. W., & Huskamp, H. A. (2001). Behavioral health services under Medicaid managed care: The uncertain implications of state variation. Psychiatric Services, 52, 447-450.
Health Care Financing Administration. (1999). National summary of Medicaid managed care programs and enrollment. Available at: http://www.hcfa.gov/medicaid/mcaidsad.htm. Retrieved January 30, 2001, from http://www.hhs.gov/news/press/ 2001pres/20010418.html
Hill, S. S., Wooldridge, J., Ciemnecki, A., CyBulski, K. C., Kolln, B., Sinclair, M., et al. (2001). SSI enrollees in TennCare: Room for improvement. In Perspectives on Medicaid managed care. Washington, DC: Mathematica Policy Research.
Holahan, J., Rangarajan, S., & Schirmer, M. (2001). Medicaid managed care payment methods and capitation rates results of a national survey. Retrieved March 15, 2001, from http://newfederalism.urban.org/html/occa26.html
Landon, B. E., & Epstein, A. M. (1999). Quality management practices in Medicaid managed care: A national survey of Medicaid and commercial health plans participating in the Medicaid program. Journal of the American Medical Association, 282, 1769-1775.
Leslie, D. L., Rosenheck, R. A., & Horwitz, S. M. (2001). Patterns of mental health utilization and costs among children in a privately insured population. Health Services Research, 36, 113-127.
Lurie, N., Christianson, J. B., Gray, D. Z., Manning, W. G., & Popkin, M. K. (1998). The effect of the Utah Prepaid Mental Health Plan on structure, process, and outcomes of care. New Directions for Mental Health Services, 78, 99-106.
Ma, C. A., & McGuire, T. G. (1998, March/April). Costs and incentives in a behavioral health carve-out. Health Affairs, 17, 53-69.
Manning, W. G., Liu, C. F., Stoner, T. J., Gray, D. Z., Lurie, N., Popkin, M., et al. (1999). Outcomes for Medicaid beneficiaries with schizophrenia under a prepaid mental health carve-out. Journal of Behavioral Health Services and Research, 26, 442-450.
McAlpine, D., & Mechanic, D. (2000). Utilization of specialty mental health care among persons with severe mental illness: The roles of demographics, need, insurance, and risk. Health Services Research, 35, 277-292.
McManus, M., Graham, R., Fox, H., Mercil, C., & Irwin, C. (2000). How far have state Medicaid agencies advanced in performance measurement for children. Archives of Pediatrics and Adolescent Medicine, 154, 665-6671.
Mechanic, D. (1999). Mental health and social policy: The emergence of managed care (4th ed.). Boston: Allyn and Bacon.
Mechanic, D., & Aiken, L. H. (Eds.). (1989). Paying for services: Promises and pitfalls of capitation. In New directions for mental health services. San Francisco: Jossey-Bass.
Mechanic, D., & McAlpine, D. (1999). Mission unfulfilled: Potholes on the road to mental health parity. Health Affairs, 18, 7-21.
Nicholson J., Young S. D., Simon, L., Bateman, A., & Fisher, W. H. (1996). Impact of Medicaid managed care on child and adolescent emergency mental health screening in Massachusetts. Psychiatric Services, 47, 1344-1350.
Norton, E. C., Lindrooth, R. C., & Dickey, B. (1997). Cost-shifting in a mental health carve-out for the AFDC population. Health Care Financing Review, 1, 185-196.
Norton, E. C., Lindrooth, R. C., & Dickey, B. (1999). Cost-shifting in managed care. Mental Health Services Research, 1, 185-196.
Porter, E. H., & Winkler, W. E. (1998). Approximate string comparison and its effects on an advanced record linkage system. Washington DC: US Bureau of the Census, Statistical Research Division.
SAMHSA. (2001). Coordinating center for managed care and vulnerable populations evaluation project. Retrieved November 19, 2001, from http://www.hsri.org/coord.html
Scholle, S. H., Kelleher, K. J., Childs, G., Mendeloff, J., & Gardner, W. P. (1997). Changes in Medicaid managed care enrollment among children. Health Affairs, 16, 164-170.
Stoner, T. W., Manning, J., Christianson, D., & Gray, M. S. (1997). Expenditures for mental health services in the Utah Prepaid Mental Health Plan. Health Care Financing Review, 18, 73-93.
Stroul, B. A., Pires, S. A., Armstrong, M. I., & Meyers, J. C. (1998). The impact of managed care on mental health services for children and their families. The Future of Children: Children and Managed Care, 8, 119-133.
U.S. Dept of Health and Human Services. (2001). Press Release 4/18/2001; HHS approves extension of Colorado Medicaid managed mental health plan. Retrieved May 10, 2001, from http://www.hhs.gov/news
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Hutchinson, A.B., Foster, E.M. The Effect of Medicaid Managed Care on Mental Health Care for Children: A Review of the Literature. Ment Health Serv Res 5, 39–54 (2003). https://doi.org/10.1023/A:1021707525105
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DOI: https://doi.org/10.1023/A:1021707525105