Step Two Policy Project says New York received approvals in 2015 to bring mental health and substance use disorder services under Medicaid managed care.
A review of Medicaid managed care
According to an issue brief from the Step Two Policy Project, Adrienne Anderson examines behavioral health under managed care in New York Medicaid. The brief includes a foreword by Paul Francis, which describes the policy direction of Governor Cuomo’s first Medicaid Redesign Team, or MRT.
The foreword says the MRT’s central organizing principle was “care management for all.” Its goal was to include all Medicaid services under managed care, according to the Step Two Policy Project. The approach reflected a view that fragmented, fee-for-service Medicaid was linked to poor outcomes and high costs because no single entity was accountable for coordinating care across a person’s full range of needs.
Populations outside managed care
The Step Two Policy Project says that by 2015, New York had enrolled the bulk of its mainstream Medicaid population in managed care. However, the source says several large and high-cost groups remained in fee-for-service Medicaid.
Those groups included people with serious mental illness, people with substance use disorders, older adults, and people with disabilities, according to the brief. The source says these groups were often kept out of managed care through carve-outs that were justified by clinical complexity.
The MRT’s rationale
According to the Step Two Policy Project, the MRT viewed this arrangement as a structural problem. The source says the people with the greatest needs and highest costs were outside the system intended to manage and coordinate care.
In 2015, New York received the approvals needed to implement MRT Recommendation 93, which brought mental health and substance use disorder services into managed care, the Step Two Policy Project reports. The brief says the policy logic was that untreated behavioral health problems can cause or worsen physical health problems.
The source further states that effective treatment of behavioral health issues can be an indispensable part of managing chronic physical health conditions.
What this means for New York patients
For New Yorkers trying to find treatment locally, this history helps explain the Medicaid managed care framework around behavioral health services. The directory lists 223 published clinics in New York.
This is general information, not medical advice.
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This report is educational and is not medical advice. Coverage, availability and eligibility can change; verify details with the named source or your care team.