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Reported Strategies by Medicaid Managed Care Organizations to Improve Access to Behavioral Health Services.

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Title: Reported Strategies by Medicaid Managed Care Organizations to Improve Access to Behavioral Health Services.
Authors: ZHU, JANE M. (AUTHOR), ROWLAND, RUTH (AUTHOR), SUNESON, INGA (AUTHOR), COHEN, DEBORAH J. (AUTHOR), McCONNELL, K. JOHN (AUTHOR), POLSKY, DANIEL (AUTHOR)
Source: Milbank Quarterly. 2025 Suppl 1, Vol. 103, p297-318. 22p.
Subjects: Health services accessibility, Policy sciences, Managed care programs, Mental health services, Mental health, Diffusion of innovations, Interviewing, Health policy, Primary health care, Strategic planning, Research methodology, Medicaid, Health maintenance organizations
Abstract: Policy PointsDespite the growing role of managed care organizations (MCOs) in financing and delivering behavioral health services in Medicaid, little is known about MCO strategies to overcome critical access barriers and the factors influencing these strategies.Through semistructured interviews of 27 administrators and executives across 19 local, regional, and national Medicaid MCOs, we describe a number of reported approaches to enhance behavioral health access: 1) contracting with core groups of Medicaid‐focused behavioral health providers to provide a substantial share of care, and 2) targeted strategies to enhance the existing workforce through outreach, training, and workforce support programs; rate enhancements; telehealth and mobile unit care models; and high‐touch case management.Findings highlight MCO perspectives on barriers and facilitators of access to behavioral health care, as well potential strategies that hold promise for other MCOs. Future research should evaluate the outcomes associated with these strategies and identify best practices that can be adapted across MCOs. Context: Behavioral health access gaps are well documented in Medicaid, in which managed care now covers most enrollees, and for which there are typically fewer options for going out‐of‐network for care. Despite the growing role of managed care organizations (MCOs) in financing and delivering behavioral health services, little is known about MCO levers that can improve access to care. Methods: We interviewed 27 administrators and executives across 19 Medicaid MCO carriers with local, regional, or national operating presence to understand strategies to address behavioral health access barriers and the factors influencing these strategies. To achieve maximum heterogeneity, we employed iterative purposive sampling using a sampling matrix of plan and state characteristics. One‐hour interviews were recorded, professionally transcribed, and analyzed using a coding scheme that was developed iteratively. Codes were bundled into major themes after iterative discussions, with analysis conducted at the MCO level. Findings: MCOs perceived acute access challenges for children and adolescents, rural geographies, and crisis and transitional services. To address these challenges, MCOs reported contracting with core groups of Medicaid‐focused behavioral health providers, supplemented with targeted strategies to enhance the existing workforce. These strategies focused on enhancing provider retention and capacity through outreach, training, and workforce support programs; rate enhancements; telehealth and mobile unit care models; and high‐touch case management to align members to appropriate providers or service levels. Strategies were influenced by state policy contexts, including by regional financing and organization of behavioral health services, rate setting procedures, and administrative and regulatory requirements. Conclusions: As state Medicaid programs increasingly grapple with behavioral health access gaps, understanding MCO approaches and common challenges may help policymakers better align resources, incentives, and regulations centered on improving existing gaps in accessing behavioral health care. Future research should evaluate the outcomes associated with MCO perceptions and accompanying strategies and identify best practices that can be adapted across MCOs. [ABSTRACT FROM AUTHOR]
Copyright of Milbank Quarterly is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Reported Strategies by Medicaid Managed Care Organizations to Improve Access to Behavioral Health Services.
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  Label: Abstract
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  Data: Policy PointsDespite the growing role of managed care organizations (MCOs) in financing and delivering behavioral health services in Medicaid, little is known about MCO strategies to overcome critical access barriers and the factors influencing these strategies.Through semistructured interviews of 27 administrators and executives across 19 local, regional, and national Medicaid MCOs, we describe a number of reported approaches to enhance behavioral health access: 1) contracting with core groups of Medicaid‐focused behavioral health providers to provide a substantial share of care, and 2) targeted strategies to enhance the existing workforce through outreach, training, and workforce support programs; rate enhancements; telehealth and mobile unit care models; and high‐touch case management.Findings highlight MCO perspectives on barriers and facilitators of access to behavioral health care, as well potential strategies that hold promise for other MCOs. Future research should evaluate the outcomes associated with these strategies and identify best practices that can be adapted across MCOs. Context: Behavioral health access gaps are well documented in Medicaid, in which managed care now covers most enrollees, and for which there are typically fewer options for going out‐of‐network for care. Despite the growing role of managed care organizations (MCOs) in financing and delivering behavioral health services, little is known about MCO levers that can improve access to care. Methods: We interviewed 27 administrators and executives across 19 Medicaid MCO carriers with local, regional, or national operating presence to understand strategies to address behavioral health access barriers and the factors influencing these strategies. To achieve maximum heterogeneity, we employed iterative purposive sampling using a sampling matrix of plan and state characteristics. One‐hour interviews were recorded, professionally transcribed, and analyzed using a coding scheme that was developed iteratively. Codes were bundled into major themes after iterative discussions, with analysis conducted at the MCO level. Findings: MCOs perceived acute access challenges for children and adolescents, rural geographies, and crisis and transitional services. To address these challenges, MCOs reported contracting with core groups of Medicaid‐focused behavioral health providers, supplemented with targeted strategies to enhance the existing workforce. These strategies focused on enhancing provider retention and capacity through outreach, training, and workforce support programs; rate enhancements; telehealth and mobile unit care models; and high‐touch case management to align members to appropriate providers or service levels. Strategies were influenced by state policy contexts, including by regional financing and organization of behavioral health services, rate setting procedures, and administrative and regulatory requirements. Conclusions: As state Medicaid programs increasingly grapple with behavioral health access gaps, understanding MCO approaches and common challenges may help policymakers better align resources, incentives, and regulations centered on improving existing gaps in accessing behavioral health care. Future research should evaluate the outcomes associated with MCO perceptions and accompanying strategies and identify best practices that can be adapted across MCOs. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of Milbank Quarterly is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1111/1468-0009.70009
    Languages:
      – Code: eng
        Text: English
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        PageCount: 22
        StartPage: 297
    Subjects:
      – SubjectFull: Health services accessibility
        Type: general
      – SubjectFull: Policy sciences
        Type: general
      – SubjectFull: Managed care programs
        Type: general
      – SubjectFull: Mental health services
        Type: general
      – SubjectFull: Mental health
        Type: general
      – SubjectFull: Diffusion of innovations
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      – SubjectFull: Interviewing
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      – SubjectFull: Primary health care
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      – SubjectFull: Strategic planning
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      – SubjectFull: Research methodology
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      – SubjectFull: Medicaid
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      – SubjectFull: Health maintenance organizations
        Type: general
    Titles:
      – TitleFull: Reported Strategies by Medicaid Managed Care Organizations to Improve Access to Behavioral Health Services.
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              Text: 2025 Suppl 1
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