Reported Strategies by Medicaid Managed Care Organizations to Improve Access to Behavioral Health Services

Context: Behavioral health access gaps are well documented in Medicaid, in which managed care now covers most enrollees, and for which there are typically fewer options for going out-of-network for care. Despite the growing role of managed care organizations (MCOs) in financing and delivering behavioral health services, little is known about MCO levers that can improve access to care.

Methods: We interviewed 27 administrators and executives across 19 Medicaid MCO carriers with local, regional, or national operating presence to understand strategies to address behavioral health access barriers and the factors influencing these strategies. To achieve maximum heterogeneity, we employed iterative purposive sampling using a sampling matrix of plan and state characteristics. One-hour interviews were recorded, professionally transcribed, and analyzed using a coding scheme that was developed iteratively. Codes were bundled into major themes after iterative discussions, with analysis conducted at the MCO level.

Findings: MCOs perceived acute access challenges for children and adolescents, rural geographies, and crisis and transitional services. To address these challenges, MCOs reported contracting with core groups of Medicaid-focused behavioral health providers, supplemented with targeted strategies to enhance the existing workforce. These strategies focused on enhancing provider retention and capacity through outreach, training, and workforce support programs; rate enhancements; telehealth and mobile unit care models; and high-touch case management to align members to appropriate providers or service levels. Strategies were influenced by state policy contexts, including by regional financing and organization of behavioral health services, rate setting procedures, and administrative and regulatory requirements.

Conclusions: As state Medicaid programs increasingly grapple with behavioral health access gaps, understanding MCO approaches and common challenges may help policymakers better align resources, incentives, and regulations centered on improving existing gaps in accessing behavioral health care. Future research should evaluate the outcomes associated with MCO perceptions and accompanying strategies and identify best practices that can be adapted across MCOs.