State
Mental Health Agencies (SMHAs) are the state government agencies charged with
organizing, delivering, and financing services to persons with severe mental illnesses
in every state. Collectively, SMHAs are responsible for the delivery of mental
health services to over 6 million persons each year and control over $30
billion in expenditures for this care. The persons served by SMHAs are
frequently minorities (31%), unemployed (22% were employed), lack private
health insurance (54% receive Medicaid), and often have serious mental
illnesses or emotional disturbances (66%).
Because
mental health services in America are largely organized at the state level, and
every state organizes its mental health system differently, SMHAs’ experiences
in financing mental health services provide both a learning opportunity and
challenge to the mental health field.
SMHAs
report that on average, 54% of mental health consumers have Medicaid paying for
at least part of their mental health treatment. However, SMHAs vary widely in
the proportion of the persons served who use Medicaid, from a high of 100% of
persons served by the Maine SMHA and 88% of persons served in Maryland to 19% of
persons served in North Dakota and 23% of persons served in Nebraska.
State general revenue funds remain the largest single
source of funding (63%) for SMHAs, but Medicaid has been the fastest growing
source of funds for the last 20 years and now accounts for 42% ($12.5 billion).
SMHAs vary widely regarding how much they rely on Medicaid for the
SMHA-controlled expenditures (from a high of 86% in Washington and 84% in Rhode
Island to a low of 2% in Hawaii and 4% in Connecticut.
States
vary in how much they use Medicaid Managed Care Waivers to organize the
delivery of mental health services.
While some states use Medicaid MC Waivers for almost all Medicaid
financed services, other states have no waivers and have not implemented
managed care.
The
NASMHPD Research Institute, Inc. (NRI) is working with SAMHSA and the SMHAs to
identify and track the different financing methods used by states. Working with
the new NASMHPD Financing and Medicaid Division, the NRI is updating its state
MH Agency Profiles system to better track and identify new financial
approaches, the use of Medicaid, and the impact of state and federal parity
laws on the public mental health system.
Results from this new compilation will be available in early 2009.
As
the discussion above indicates, SMHAs vary widely in how they organize and
finance their mental health systems. As a result of this variation, changes in
rules for financing mental health services through Medicaid or Medicare,
private insurance parity, and redirection of state general fund dollars will
have a different impact on each state. However, these variations may also allow
SAMHSA and the new Financing Center of Excellence to identify numerous natural
experiments in financing of mental health services among the states.
