Evaluation of Florida's Medicaid prepaid mental health plans: Year 6 report

Publication Date: 6/1/2003

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Description:

Florida's Agency for Health Care Administration (AHCA) began implementing managed behavioral health care in March 1996. For the past six 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 designed to assess the effects of the Prepaid Mental Health Plan (PMHP) demonstrations 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. In this report we present the findings for the more recently implemented demonstration project in the Florida Panhandle region, AHCA 1, as well as findings from year 6 of our continuing evaluation of the Prepaid Plan operating in AHCA Area 6, the Tampa Bay region.

In the evaluation, we continue to contrast the PMHPs and HMOs with comparison sites, where services continue to be paid for on a fee-for-service basis. Medicaid participants enrolled in the PMHPs in Areas 1 and 6 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 some 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.