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SAMHSA News - January/February 2008, Volume 16, Number 1


State by State: Medicaid and Mental Health Services

By Riggin Waugh

Although state Medicaid agencies play increasing roles in funding, managing, and monitoring state mental health services, little is known about how each agency administers these services. To fill the information gap, SAMHSA recently released a report providing a synthesis of national findings, as well as state-by-state data.

The report, Administration of Mental Health Services by Medicaid Agencies, summarizes the results of in-depth telephone interviews with state Medicaid directors or their designees in all 50 states and the District of Columbia.

While Federal law requires that the Medicaid agency must retain ultimate authority over all aspects of the Medicaid program, states may delegate responsibility to other state agencies or to private contractors for certain activities.

In some states, the Medicaid agency holds full administrative responsibility for all mental health services if services are funded with Medicaid dollars and provided to Medicaid enrollees. Other states share responsibilities with other state agencies.

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Survey Results

The SAMHSA survey explored how state Medicaid agencies manage responsibilities for mental health services.

Organizational structure. In most states, the Medicaid director reports directly to the governor or is separated by only one reporting level. State Medicaid and mental health agencies are within the same umbrella agency in 28 states—most commonly health and human services—and are separate in 23 states.

Funding. In 26 states, the state match for Medicaid mental health services comes at least partially from a different source than the state general fund, most frequently from counties or other local sources. In 32 states, the state match for Medicaid mental health services comes at least partially from the mental health agency.

Providers. The majority of states restrict Medicaid providers of mental health services to those with a mental health designation, and 22 states delegate the enrollment of mental health providers to the mental health agency. Twenty-six states reported that at least some Medicaid mental health services or populations are covered through behavioral health organizations or administrative services organizations.

Data and reporting. Forty states reported that their Medicaid agencies produce formal reports containing data on Medicaid mental health use or expenditures, while 27 states reported that the mental health agency produces these reports. More than three-quarters of states make data from the Medicaid Management Information System available to the mental health agency for analysis, but few states have linked client-level data.

Collaboration. Slightly more than half of state Medicaid agencies said Medicaid and mental health agencies collaborate frequently through internal and external meetings, public reports, or presentations to the legislature. Medicaid and mental health agency collaboration tends to be highest in states where both agencies are in the same umbrella agency, and lowest where they are in separate agencies and where the mental health agency has authority to set some Medicaid rates.

Authority. Medicaid agency authority over mental health funding, provider rate setting, and data appears to be highest when Medicaid and mental health agencies operate separately and there are limited opportunities for Medicaid to use the public mental health system. Medicaid agency authority tends to be lower when the agencies are part of the same umbrella agency and the public mental health system can administer Medicaid services.

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More Information

Administration of Mental Health Services by Medicaid Agencies uses data from interviews with Medicaid directors conducted during the last half of 2005 and early 2006. The survey response rate was 100 percent.

For free print copies, call SAMHSA’s Health Information Network at 1-877-SAMHSA-7 (1-877-726-4727) or 1-800-487-4889 (TDD). Request inventory number SMA07-4301.

For a free PDF copy of this report, visit http://mentalhealth.samhsa.gov/publications/allpubs/sma07-4301.

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