Medicaid Handbook: Interface with Behavioral Health Services

This detailed and comprehensive handbook reviews Medicaid and its role in financing services and treatment for mental health disorders and substance use disorders. The handbook discusses services included in state Medicaid plans, the role of provider reimbursement, and a wide range of other important factors related to Medicaid.

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Module 1: Medicaid’s Importance to Mental Health and Substance Use Services

Medicaid plays a significant role in the financing of treatment for mental or substance use disorders. The Federal-State Medicaid program is currently the single largest funder of behavioral health services. This module explains Medicaid’s role in behavioral health services and how it has changed over time. The module also explains how Medicaid spending on behavioral health services differ by state, will be impacted by the Affordable Care Act, and compare to spending by other payers. Read Module 1 [PDF | 407 KB]

Module 2: Medicaid Overview

Medicaid is a health coverage program jointly administered by the federal government and each state government. This module provides an overview of the federal laws and regulations that define the Medicaid program, the federal agency responsible for administering the program, and its relationship with the states. This module also provides an overview of who is eligible for the Medicaid program and how the program is financed in partnership with states. Read Module 2 [PDF | 456 KB]

Module 3: The Medicaid Behavioral Health Services Benefit Package

Creation of a state’s Medicaid behavioral health benefit package is a multidimensional process. This module provides an overview of behavioral health services provided as a part of state plans, waivers, managed care programs, and case management programs. This module also provides an analysis of the Good and Modern Addictions and Mental Health Service System services. Read Module 3 [PDF | 298 KB]

Module 4: Providers of Behavioral Health Services

States have latitude within the bounds of federal statute and legislation in defining the types and qualifications of providers that may participate in their Medicaid programs. This module explains the difference between a service and a provider and reviews the role of Medicaid in working with a range of important behavioral health provider types. Read Module 4 [PDF | 274 KB]

Module 5: Structure and Reimbursement Methodologies

A state can choose to operate its Medicaid program using a fee-for-service (FFS) framework, a managed care framework, or a combination of the two. FFS and managed care are service delivery structures, but they are also types of reimbursement arrangements. States have significant latitude in deciding how to structure reimbursement methodologies for the Medicaid services they provide. This module reviews the authorities states may use in structuring their reimbursement regime and summarizes a wide range of reimbursement methodologies. Read Module 5 [PDF | 356 KB]

Module 6: Care Coordination Initiatives

The health care environment at the federal and state level is ripe with ideas aimed at improving coordination of consumer care. The coordination efforts are intended to improve delivery system performance and lower health care costs. This module provides information on a range of important coordinated and integrated health care models that aim to increase quality outcomes in Medicaid programs today. Read Module 6 [PDF | 265 KB]

Module 7: Recent Federal Legislation and Medicaid and Medicare

This module examines the relationship of two major recent pieces of federal legislation—the Mental Health Parity and Addiction Equity Act (MHPAEA) and the Affordable Care Act—to the existing Medicaid and Medicare programs, and the importance of these laws to behavioral health care and the people who have mental and substance use disorders. Read Module 7 [PDF | 359 KB]

Module 8: The Relationship Between Medicare and Medicaid

Medicare is a health insurance program primarily for older adults and people with disabilities. Unlike Medicaid, Medicare is administered entirely by the federal government. Medicare funding comes from several sources, including Medicare payroll taxes, beneficiary premiums, and federal general revenue. This module provides an overview of the role of the Medicare program in providing services for individuals with behavioral health needs and explores the relationship between Medicare and Medicaid for individuals enrolled in both programs. Read Module 8 [PDF | 255 KB]

Module 9: Practical Guides to Medicaid State Plans and Waivers

A state’s Medicaid State Plan is a contractual agreement, approved by the Centers for Medicare & Medicaid Services (CMS), that describes the nature and scope of the state’s Medicaid program. The State Plan dictates the policies and procedures that a state will follow in administering its Medicaid program, including those related to the methods of administration, eligibility criteria, covered services, and reimbursement methodologies. This module provides examples of state plans and an overview of the process of amending a state plan. This module also provides examples of waivers and waiver amendments and reviews the process for applying for or amending a waiver. The processes and regulations that are described in this module are from the federal perspective only. Read Module 9 [PDF | 279 KB]

Module 10: Basic Information and Tools

This module provides basic information and tools for anyone wishing to apply the principles of Medicaid to their existing knowledge of behavioral health services. It discusses everything from finding what you need to know about Medicaid in your state to how to find relevant federal laws and regulations. Read Module 10 [PDF | 222 KB]

Last Updated: 07/24/2014