Recipients

Wisconsin Medicaid and BadgerCare Fact Sheet Mental Health in Managed Care

Background

• Medicaid-contracted HMOs are required to provide all medically necessary mental health services that would be covered under fee-for-service Medicaid.
• For the BadgerCare/AFDC HMOs, utilization of mental health services is routinely reported as part of the HMO comparison reports. These reports show that utilization of mental health services is increasing.
  • 7.3% of HMO enrollees received mental health or substance abuse evaluation services in 1997.
  • By 1999, the percent had risen to 8.1%.

Access

• The BadgerCare/AFDC HMOs must have:
  • A mental health or substance abuse provider within a 35-mile distance from any enrollee residing in the HMO service area; or
  • A provider located no further than the distance for non-enrolled recipients residing in the service area.
• A 1998 audit concluded that access to mental health services is not a problem. That audit showed that individuals who had a diagnosis of mental illness but had not received services:
  • Had either been offered services that they refused; or
  • Were children being treated for Attention Deficit Disorder by a pediatrician who did not code his services as mental health.
• Specialized managed care programs (Independent Care, Wraparound Milwaukee or Children Come First) must provide all mental health services identified in the patient’s treatment plan.

Other Oversight Activities

• In 2000, the Division of Health Care Financing looked at encounter data to determine if the HMOs were denying or making it difficult to obtain mental health services after a specific number of visits. The encounter data did not support this perception.
• A mental health provider survey is being planned for the near future to determine if providers can identify barriers to managed care enrollees receiving appropriate services.

Satisfaction Surveys

• Both the Mental Health Satisfaction Survey (MHCSS) and the Consumer Assessment of Health Plan Satisfaction (CAHPS) Survey indicate that most recipients are satisfied with the mental health treatment they receive.
• On the most recent CAHPS survey, 64% of respondents rated their experience getting mental health services an 8, 9, or 10 on an 11-point scale where 11 is the highest possible score. Only 13.2% rated their experience below 5.
• Of the respondents to the MHCSS:
  • 80% indicated their clinic was able to see them when they wanted.
  • 86% agreed that their therapist understood and respected their culture, beliefs and values.
  • 88% indicated they would recover and get better.
• Both Children Come First and Wraparound Milwaukee are small programs with the parents having input by functioning as part of the treatment team.
• Participation in Independent Care is voluntary, and member satisfaction is high in their annual member surveys.

Last updated: 4/17/02