Published in 2000, this report synthesizes the collective experience of four managed behavioral health care organizations (MHBOs) that hold public sector managed care carve-out contracts. 

From the report:

In the public sector, over 70 percent of the 21 States with Medicaid carve-outs for behavioral health services contract with these MBHOs. The discussion and interviews examined practices used in public sector managed care contracting. Today, fewer MBHOs are bidding on State and local public sector contracts. Preparing a responsive proposal has become extremely expensive because of an increasing number of program design specifications. Study participants predicted that States will see even less competition for those programs that require a large investment from MBHOs for marketing, start-up, and ongoing administration yet offer little potential for financial reward.

Full report: http://mentalhealth.samhsa.gov/publications/allpubs/SMA00-3438/default.asp

U.S. Dept. of Health and Human Services, Substance Abuse and Mental Health Administration (SAMHSA). (2000). Special report: Contracting for public mental health services opinions of managed behavioral care organizations. Savela, T., Robinson, G., Crow, S.