Headline
The transition to the Medicaid behavioral health “carve-in” model in Washington State was not associated with significant improvements in overall health outcomes.
Context
Many state Medicaid programs, including Washington’s, have transitioned from financing behavioral health services “carved out” of the overall medical benefit package to a “carved in” model, where behavioral health services are integrated with the medical benefits provided under Medicaid managed care organizations. There is little evidence on the effects of the behavioral health carve-in model in care delivery. This study reviewed claims from over 450,000 Medicaid members in Washington State from January 2014 to December 2019 to analyze impact of the transition to a carve-in model on utilization, quality measures, and health-related outcomes.
Findings
There were no significant changes in claims-based utilization for outpatient mental health visits, primary care visits, emergency department visits, or hospitalizations for mental health conditions among individuals with serious mental illness, mild to moderate mental illness, or no mental illness. There were also no significant changes to other outcomes in the analysis, including mental health or physical health outcomes, health-related social needs (e.g., homelessness, arrest, employment), and quality measures.
Interviews with 24 stakeholders, including community leaders, providers, and managed care staff, revealed no significant changes in care delivery as a result of the administrative transition to the carve-in model.
Takeaways
Financial integration of behavioral health services into Medicaid managed care is only one component to consider when aiming to improve access to care and services, as well as member outcomes. Based on these study results, Medicaid programs should consider other levers described in the article — such as training, incentives, and supports — to improve clinical integration.