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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