Iowa Medicaid

Iowa Medicaid – Iowa’s Medicaid health services

Achieving success step-by-step

In 1993, the State of Iowa projected that by 1995 it would spend more than $50 million on mental health services for Medicaid enrollees. The state had already had a positive experience with its medical/surgical managed care initiatives and wished to expand managed care into the area of mental health. So Iowa awarded a two-year contract to Merit Behavioral Care Corp. of Iowa (MBCI) to provide managed behavioral health care to Medicaid enrollees under the state’s Mental Health Access Plan (MHAP), starting on March 1, 1995.

Compared to the general population, a higher portion of Medicaid enrollees have serious and persistent mental illness. This patient group needs long-term support to ensure recovery and enhanced functioning, not just episodic care. Recognizing that Medicaid enrollees require a variety of psychosocial services to ensure that they get the maximum benefit from improved access to behavioral health care, MBCI created innovative ways to meet these needs.

Until Merit assumed the MHAP contract two years ago, Medicaid had funded only traditional mental health services, with inpatient care widely available, readily funded and therefore used more heavily than necessary. During the first six months of the contract, MBCI and the Department of Human Services worked to develop a statewide network of providers to help with everything from mobile crisis to respite and community services.

One of the first managed care organizations to implement a statewide public reinvestment initiative, MCBI has reinvested $2 million in mental health projects – funds it has saved the state since assuming management of the MHAP program. Projects address utilization patterns, with the goal of reducing hospitalization by providing alternative community-based care. Each project is locally driven with funds distributed geographically, but with a focus on Iowa’s rural population.

In cooperation with the Department of Human Services, Merit identified providers who had previously worked with Medicaid and showed an interest in providing alternative services. MBCI also consulted with consumer advocacy groups to identify providers accustomed to public sector clients.

Provider outreach meetings were conducted to explain the principles of managed care and the application/contracting process. MBCI modified credentialing standards to fit utilization management guidelines for a broad array of clinical and psychosocial service programs and used the Iowa Communications Network satellite system to conduct interactive sessions on the expansion of alternative services.

Network providers and consumerrun program leaders were asked to submit proposals for expanding their array of services in the direction of community-based support and treatment. A multidisciplinary team was formed to identify, select and contract with a range of local mental health projects. Potential investment sites were identified through provider and consumer focus groups, extensive community outreach meetings, input from the Department of Human Services and proposals from local providers. Successful sites guaranteed local links with social services agencies, adhered to mutually agreed upon performance measures, supported and individualized a service approach emphasizing consumer choice and participation and offered mental health services that had not been available through the traditional Medicaid system.

MHAP has achieved much that MBCI and the Iowa Department of Human Services take pride in. Perhaps the most important accomplishment to date is improved access to services and a related decrease in inpatient length of stay. This has been accomplished at a significant savings – 14 percent lower than projected traditional fee-for-service costs. In the first published survey, 86 percent of patients showed satisfaction with MHAP.

For more information on Merit, call 1-800-436-4111 or visit us at www.mbc-net.com.

COPYRIGHT 1997 A Thomson Healthcare Company

COPYRIGHT 2004 Gale Group