State Level Mental Health Policy Making Under Managed Care

279 p.Thesis (Ph.D.)--University of Illinois at Urbana-Champaign, 2008.The adoption of managed care in public mental health care programs at the state level was a relatively new development in state mental health policy during the 1990s. The introduction of managed care for public mental health occurred primarily through the use of Medicaid managed care waivers, but not all states used this method, and not all states adopted mental health managed care programs during that time. This dissertation investigated the extent to which the adoption of managed care in state-level public mental health care programs was associated with state performance on the mental health policy goals of cost containment and deinstitutionalization. Thirty-eight states were managed care adopters, and thirteen were non-adopters of managed care for mental health during the 1990s. Between 1981 and 2003, all states experienced substantial increases in total spending for public mental health care services, as well as for the community-based care component of total spending. When adjusted for inflation, spending for hospital inpatient care was stable over the entire time period of the analysis. The use of managed care was associated with substantially larger increases in state public expenditures for community-based mental health services and total mental health care services, as well as a slight reduction in spending for hospital inpatient services, compared to not using managed care for mental health. All states were successful at reducing the number and length of stay of public mental health clients cared for in inpatient hospital settings, but because of data limitations, this study was not able to track whether this reduction of inpatient care was matched by a concomitant increase in service utilization in community care programs.U of I OnlyRestricted to the U of I community idenfinitely during batch ingest of legacy ETD