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Is Florida Showing Us the Future of Behavioral Health Care in Medicaid?

This month Florida began offering its Medicaid beneficiaries with serious mental illnesses a choice to enroll in a special comprehensive and integrated managed care plan that coordinates physical and mental health services. The move could be a big deal for people in Medicaid who have a serious mental illness. Since specialty mental health benefits are carved out of managed care in Medi-Cal, stakeholders, policymakers, and all interested movers and shakers in California should be watching this new program to see what important lessons we can learn from it.

There are many reasons to believe that a program like Florida’s could have benefits for people with serious mental illness. People with serious mental illness need more services than other beneficiaries overall. Many individuals with mental illnesses also have physical health conditions, causing their treatments to be more complicated and costly, and to require more coordination.[1] With a comprehensive set of benefits coordinated and managed through one plan, Florida’s Medicaid program could increase access to care and services, as well as control costs for this high-need population. Since Medicaid beneficiaries are twice as likely as other individuals to have these conditions, [2] a substantial number of people could see improved care from this program (up to 140,000 in Florida) if it is successful.[3]

California has some experience with creating comprehensive health plans for groups of beneficiaries with special needs. The Florida program is somewhat similar to pilots that California has created for Medi-Cal enrollees also enrolled in Medicare (also known as the “dual eligibles”), a mostly elderly group with more intense health care needs. The Cal MediConnect program, which coordinates all health and long-term supports and services for this group, has a similar goal to offer more coordinated care, better health outcomes, and cost control. The Cal MediConnect pilot began to enroll beneficiaries in certain counties starting in April of this year. Although we still have yet to see what the effects of this program will be, it offers an important link between two public programs that covered different sets of services with minimal coordination, often resulting in very fragmented care for the consumer. The extensive planning that was needed to launch the Cal MediConnect program could provide some of the groundwork for future mental and physical health service coordination in Medi-Cal.

While Florida may not be a pace car for us to follow in certain ways (e.g., not expanding its Medicaid program through the ACA), its plan for people with serious mental illness has some innovative pieces. The state is requiring the managed care plan to use interdisciplinary teams of primary care providers, nurses, and specialists to serve patients, along with a personal health guide to coordinate care and help beneficiaries follow treatment plans. The health plan will also be required to incorporate families into treatment plans and offer a support group for each patient.

Interestingly, the state will also be paying the managed care plan 5% less per member per month than it would spend on average in FFS Medicaid. The goal will be to achieve savings by reducing avoidable hospitalizations and other expensive treatments. In sum, the program looks pretty darn ambitious.

If Florida sees some success with this approach, we should take a hard look at the way that we’ve been organizing care for this group in California. We have some excellent and exciting initiatives going on in behavioral health in Medi-Cal, and we should only try to build upon them when we see successful innovations that we can incorporate from other states’ programs.

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[1]Kronick R et al. 2009. The Faces of Medicaid III: Refining the Portrait of People with Multiple Chronic Conditions, Center for Health Care Strategies. Available at: http://www.chcs.org/publications3960/publications_show.htm?doc_id=1058416

[2] Kronick R, et al. Op cit.

[3] Kaiser Health News. 2014. Florida Shifts Medicaid Mental Health Strategy. Available at: http://www.kaiserhealthnews.org/Stories/2014/July/07/florida-program-for-mental-health-coverage.aspx

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