Medicaid managed mental health care arrangements in AHCA Area 6: Organizational, financial and clinical structures

Publication Date: 1998

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Description:

This report, the first full report on the organizational, financial and clinical structures of the managed mental health care interventions in AHCA Area 6, is presented in the following sections. In Section 2 , we describe the methods used to identify, obtain and analyze information on the nine managed care plans operating in Area 6. In Section 3, we provide a chronology of events related to Medicaid managed care and then describe the Medicaid service delivery system in AHCA Area 6, providing contextual data on the number of Medicaid recipients enrolled in managed care plans, the number of MCOs and their enrollment, as well as a summary of the trends in enrollment. Section 4 provides a review of factors that are common across the carve in and carve out plans - that is, the benefit package, the performance indicators, the rate setting formula, and the service networks. Section 5 provides a detailed analysis of each of the nine managed care plans, focusing on the following key aspects of their operations: corporate affiliation and managed care organization (MCO) structure; functions, including the roles of subcontractors; geography and enrollment of the plan; network composition; payment and risk arrangements; clinical management structures; and coordination with general health care. As will be seen, there is much variability across the carve out and carve in conditions as well as within the carve in (HMO) condition. Section 6 provides a synthesis of the relevant findings organized around public policy concerns. Section 7summarizes the public policy implications and Section 8 presents concluding remarks.