States  contract with managed care organizations to provide a comprehensive set   Also, states may  of services to Medicaid beneficiaries; states may also contract with limited  benefit plans to provide a defined set of services, such as mental health  services. Care coordination is particularly important for Medicaid beneficiaries with  mental illnesses because they are more likely to have other medical  conditions requiring ongoing physical health care services than  beneficiaries without mental illnesses. Enrollment, Payment, and Scope of Services Varied Across All 13 States Using Limited Benefit Plans for Mental Health Services

Across the 13 states that contracted with limited benefit plans to provide  mental health services to adult Medicaid beneficiaries, the enrollment  levels, total payments, and services provided varied. States can enroll  different adult populations—such as individuals who are blind, disabled,  or have developmental disabilities—in limited benefit plans, which could  contribute to variation in the number of adults enrolled, as well as the  level of capitated payments states made to these plans.reported that about 4.4 million adult Medicaid beneficiaries were enrolled  in limited benefit plans, about 48.6 percent of all adult Medicaid  beneficiaries in the 13 states. 1.) Capitated payments to limited benefit plans providing mental health  services to adult Medicaid beneficiaries also varied across the 13 states  in fiscal year 2012. 2). Four Selected States Took Steps to Facilitate the Coordination of Mental and Physical Health Care Services

The steps that selected states—Florida, Kansas, Michigan, and  Washington—generally took to facilitate the coordination of mental and  physical health care included (1) incorporating care coordination  requirements in the contracts with limited benefit plans; (2) implementing  additional steps to coordinate care; and (3) monitoring limited benefit  plans’ implementation of care coordination. Focused care coordination studies examine a state’s coordination of  mental health and physical health care services. CMS Reviewed State Waiver Applications and Contracts with Limited Benefit Plans

GAO found that CMS did not take direct steps to facilitate the  coordination of mental and physical health care services for adult  Medicaid beneficiaries enrolled in limited benefit plans because its role is  to provide oversight of, and technical assistance to, the states in carrying  out their Medicaid programs. In its oversight role, the agency reviewed  and approved state-submitted managed care waiver applications and  contracts with limited benefit plans providing mental health services,  some of which contain care coordination provisions. Agency Comments

The Department of Health and Human Services reviewed a draft of this  report and provided technical comments, which we incorporated as  appropriate.
Why GAO Did This Study

Medicaid is the largest payer of mental health services in the United States and Medicaid spending on such services is likely to grow. Some states provide mental health services to Medicaid beneficiaries separately from physical health care services through contracts with limited benefit plans, which are paid on a per person basis to provide a defined set of services. While using these plans to provide mental health services may control costs, it can also increase the risk that these services will not be coordinated with physical health care services. Coordinated care is important for Medicaid beneficiaries with mental illnesses because they are more likely than others to have ongoing health conditions. GAO was asked for information on states' use of Medicaid managed care. In this report, GAO examined the (1) extent that states provide mental health services through limited benefit plans, and (2) steps states and CMS have taken to facilitate the coordination of mental and physical health care services for adult beneficiaries enrolled in these plans.
GAO collected information on enrollment, payments, and services from the 13 states that contracted with limited benefit plans to provide mental health services to adult beneficiaries. GAO also selected 4 states based on, among other criteria, the number of beneficiaries enrolled in limited benefit plans. GAO reviewed documents from the 4 states and CMS, and interviewed officials to identify steps taken to coordinate care.
The Department of Health and Human Services provided technical comments, which GAO incorporated, as appropriate.

What GAO Found

Thirteen states reported that in fiscal year 2012 they paid a total of about $5.6 billion to limited benefit plans to provide mental health services to about 4.4 million adult Medicaid beneficiaries. States can enroll different populations--such as adults who are blind, disabled, or have developmental disabilities--in limited benefit plans, which could contribute to the variation in the number of adults enrolled and level of capitated payments made across the 13 states.
Four selected states--Florida, Kansas, Michigan, and Washington--took three steps to facilitate the coordination of mental and physical health care services:
1. incorporating care coordination requirements in limited benefit plan contracts;
2. implementing additional steps to coordinate care, such as policies that included incentives to coordinate care; and
3. monitoring limited benefit plans' implementation of care coordination.
GAO found that the Centers for Medicare & Medicaid Services' (CMS) did not take direct steps to facilitate care coordination, because its role is to oversee and provide technical assistance. In its oversight role, CMS reviewed and approved state submitted documents, such as contracts with mental health limited benefit plans, some of which contained care coordination requirements.