Iv. Services Covered by Managed Care Reforms

One recommendation to states and communities from key stakeholders in the 1997 Impact Analysis was to include both acute and extended care services in managed care reforms. (For purposes of this study, “acute care” is defined as brief, short-term treatment with, in some cases, limited intermediate care also provided, and “extended care” is defined as care extending beyond the actute care stabilization phase, i.e., care required by children with more serious disorders and their families.) The Impact Analysis noted that inclusion of both types of services creates the potential to integrate care for a total eligible population and reduces the potential for cost shifting and for fragmentation at the service delivery level. According to the 1997-98 survey, 74% of all reforms include both acute and extended behavioral health care services. As is shown on Table 20, however, there are striking differences between carve out and integrated reforms regarding acute and extended care coverage. Only 11% of the carve out reforms reportedly are limited to acute care services. In contrast, 53% of the integrated reforms cover acute care services only, as is typical in a commercial health insurance model. As discussed more fully in the financing section of this report, typically only Medicaid dollars are used to finance integrated reforms. Eighty-nine percent of the carve outs were reported to include both acute and extended care services, as compared to only 47% of the integrated reforms. Carve outs are more likely to use public behavioral health dollars along with Medicaid dollars to finance the managed care system.