Concern about the viability of mental health "safety-net" providers has led many states to include protections for them in state Medicaid contracts with managed care organizations (MCOs). Most commonly states include contract provisions that encourage MCOs to include safety-net providers in their networks, thus protecting them from much of the competition associated with managed care. We used qualitative comparative analysis (QCA) to examine the role of four aspects of state's public health care delivery systems in influencing whether Medicaid-MCO contracts had these provisions. QCA is based on the logic and techniques of Boolean algebra and allows one to identify the multiple and conjunctural causes of an event as well as the necessary and sufficient conditions for an event to occur. QCA is particularly helpful for examining situations with complex patterns of interactions among the specified conditions. Using QCA we examined (1) stakeholders' roles (consumers and providers participation in the design and monitoring of state health systems); (2) state political climate and public attitudes about government provision of health services; (3) insulation of mental health services from non-mental healthcare (measured by carve-out status and existence of an independent implementing mental health agency); (4) bargaining strength of MCOs vis-a-vie state Medicaid agencies. The last was investigated by examining such factors as the state's need for greater numbers of MCOs and what the state could provide MCOs in terms of market size and reimbursement. This analysis used multiple sources to obtain data for twenty-nine states.
Learning Objectives: At the conclusion of the session, the participants will be able to identify the combination of factors that enable protections to exist for mental health safety-net providers
Keywords: Managed Care, Safety Net Providers
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.