The Impact of Medicaid Managed Care Plan Withdrawals on Behavioral Health Services

The proportion of Medicaid beneficiaries enrolled in managed care plans has increased dramatically over the past decade. Whereas in 1991 only 9.5 percent of Medicaid beneficiaries were enrolled in some form of managed care, the proportion had grown to 55.6 percent by June 1999, at which point there were 17.8 million Medicaid managed care enrollees. Recent headlines announcing the withdrawal of major managed care plans from state Medicaid markets suggest the potential for significant disruptions to the care received by millions of Medicaid beneficiaries. Gathering reliable data on the effects of these exits poses a significant challenge. However, the extent to which problems will ensue is likely to be driven by several factors, including aspects of the delivery system in each state and the health care needs of the Medicaid population. This column considers the risks that exits by managed care plans pose for Medicaid enrollees with mental health and substance abuse conditions. Case studies are used to explore whether the impact of plans' exiting the market is driven in part by state approaches to the delivery and financing of services for this population. (May 2001)