Does capitated Medicaid managed care disadvantage persons with a serious mental illness (SMI)? We address this question by comparing service utilization and functional outcomes of two groups of persons with SMI in Virginia: (1) those served through a capitated Medicaid program in the Tidewater area and (2) those whose services were funded under a fee-for-service model in the greater Richmond area. Two face-to-face interviews were conducted six months apart with 204 outpatients served by the Community Services Boards in Norfolk (n=92) and Richmond (n=112). The interviews gathered data on demographics, quality of life, service use, coercion, symptoms, functioning, and satisfaction. Logistic and linear regression analyses are used to test the hypothesis that incentives to substitute low-intensity for high-intensity services in the capitated plan will result in poorer functional outcomes for recipients of the capitated Medicaid benefit compared to recipients of the fee-for-service benefit. Implications for mental health policy and future research will be discussed.
Learning Objectives: As a function of attending this session, participants will 1) be able to characterize the service use differences between capitated and fee-for-service settings, 2) describe the functional status differences between capitated and fee-for-service settings, and 3) identify several implications for mental health policy and practice
Keywords: Managed Care,
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.