Effective Public Management of Mental Health Care: Views from States on Medicaid Reforms That Enhance Service Integration and Accountability

Topic:
Medicaid Mental Health

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This report distills the experience of senior officials of state and local government in adapting the techniques of managed care to the needs of persons with mental illnesses, especially severe and chronic illnesses. The theme of the report is that public managers can use many of these techniques to improve the quality and cost effectiveness of behavioral health services. However, the techniques of managed care must be modified to take into account the challenges of integrating services for persons with mental illnesses, the characteristics of patients and providers in each jurisdiction, and the requirements of public accountability.

The report is the collective work of a group of state and local officials convened by the Bazelon Center and the Fund. The Center, founded in 1972, is a nonprofit national legal advocacy organization for people with mental disabilities, working to protect their rights and promote their access to the services they need for full participation in community life. The Fund is an endowed national foundation, established in 1905, that works with decision makers in the public and private sectors to carry out nonpartisan analysis, study, research, and communication on significant issues in health policy.

Each of the officials we convened had firsthand experience with managed behavioral health care. The officials spoke frankly about their experiences and achieved consensus about the themes of the report and its structure. They also decided that the report should not call attention to the specific experience of any one state. Hence particular states are not identified within the report.

The persons who created this report as well as those who reviewed it in draft are identified in the Acknowledgments. We are particularly grateful to Charles Palmer, who served with distinction as Director of the Iowa Department of Human Services, for leading this project from its inception in 1996.

Robert Bernstein
Executive Director
Bazelon Center for Mental Health Law

Daniel M. Fox
President
Milbank Memorial Fund