Evaluation of Florida's Medicaid Prepaid Mental Health Plans: Year 5 Report

Publication Date: 6/1/2002

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Description:

In March 1996, the Florida Agency for Health Care Administration (AHCA) implemented a Prepaid Mental Health Plan (PMHP) demonstration, under the authority of a 1915B waiver from the Federal Health Care Financing Administration (now known as the Centers for Medicare and Medicaid Services). For the past five years, under contract with AHCA, we, at the Louis de la Parte Florida Mental Health Institute (FMHI), have been conducting a series of integrated, multi-method evaluation projects that are designed to assess the effects of the PMHP on access, cost, quality, and outcomes of services relative to alternative managed care arrangements, and to the traditional financing arrangements that are in use in the rest of the state. This year the analyses have been expanded to include the early implementation of a second prepaid demonstration initiated by AHCA in the Florida panhandle region, AHCA Area 1. In this year's report, we present the findings for this new demonstration project, as well as findings from year 5 of our continuing evaluation of the Prepaid Plan operating in the Tampa Bay region, AHCA Area 6.

In the Area 6 evaluation, we contrast the two managed care financing conditions (the PMHP and HMOs) with AHCA Area 4, the comparison site (Jacksonville and the surrounding counties), where services continue to be paid for on a fee-for-service basis. Medicaid participants enrolled in the PMHP have their mental health benefits provided through a specialty behavioral health managed care organization that provides or arranges for all their mental health services through a network of providers. In this behavioral health "carve out" plan, the managed care organization is paid by AHCA through a risk adjusted, fixed monthly fee per enrollee. In the HMO financing condition, HMOs receive an integrated risk-adjusted premium to provide health (including medications) and the same mental health benefits as the PMHP for their enrollees. In many instances, the HMOs subcontract on a capitated basis with behavioral health organizations (BHOs) for the provision of their mental health benefits. In both Areas 1 and 6, the PMHPs and the HMOs are at financial risk for the mental health service utilization of their enrollees.