Nine States With Behavioral Health Carve-Outs To CMOs Remain:OPEN MINDS Releases Annual Analysis On State Medicaid Behavioral Health Carve-Outs

Gettysburg, Pa. (February 22, 2019) – The new report from OPEN MINDS State Medicaid Behavioral Health Carve-Outs: The OPEN MINDS 2019 Annual Update has found that in 2019, there are nine states with Medicaid behavioral health carve-outs to care management organizations (CMOs)—four of those states are to private CMOs and five are to public entities. This is a change from 15 primary carve-outs in 2011. About 29% of the nation’s 74.7 million Medicaid beneficiaries are in Medicaid behavioral health carve-outs to CMOs. With 7% of these individuals in private CMOs organizations and 93% in public entities.

The report also found that four states have vertical carve-out plans, which integrate physical and behavioral health services for individuals with SMI. These plans represent less than 1% of the Medicaid population. This market intelligence report includes information on the trends in behavioral health financing models in state Medicaid plans, 2019 Medicaid behavioral health financing models by state, the number of Medicaid enrollees in each model, and state Medicaid plans to transition behavioral health financing, and behavioral health financing arrangements and models.

“There is a clear trend in state Medicaid programs towards integrated financing for behavioral health and physical health services. The question that remains, is whether this integrated financing is translating to integrated financing for consumers at the clinical level, explained Athena Mandros, Market Intelligence Director, OPEN MINDS. For executive teams, its particularly important that they keep an eye on these high level changes and then follow how they translate into increased integration for consumers at the clinical level via medical homes, care coordination programs, secondary carve-outs etc. It is likely that we will need both to move on the needle on caring for consumers with complex behavioral conditions”

A free summary analysis of the report can be found at: Do States Still Have Medicaid Behavioral Health Carve-Outs?. The report, State Medicaid Behavioral Health Carve-Outs: The OPEN MINDS 2019 Annual Update, is available at no charge to Premium and Elite members of The OPEN MINDS Circle and can be purchased in the OPEN MINDS shop for $495.