Assessment of medicaid managed behavioral health care for persons with serious mental illness

H. Stephen Leff, Dow A. Wieman, Bentson H. McFarland, Joseph P. Morrissey, Aileen Rothbard, David L. Shern, A. Michael Wylie, Roger A. Boothroyd, T. Scott Stroup, I. Elaine Allen

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


Objectives: This five-site study compared Medicaid managed behavioral health programs and fee-for-service programs on use and quality of services, satisfaction, and symptoms and functioning of adults with serious mental illness. Methods: Adults with serious mental illness in managed care programs (N=958) and fee-for-service programs (N=1,011) in five states were interviewed after the implementation of managed care and six months later. After a multiple regression to standardize the groups for case mix differences, a meta-analysis using a random-effects model was conducted, and bioequivalence methods were used to determine whether differences were significant for clinical or policy purposes. Results: A significantly smaller proportion of the managed care group received inpatient care (5.7 percent compared with 11.5 percent). The managed care group received significantly more hours of primary care (4.9 compared with 4.5 hours) and was significantly less healthy. However, none of these differences exceed the bioequivalence criterion of 5 percent. Managed care and fee for service were "not different but not equivalent" on 20 of 34 dependent variables. Cochrane's Q statistic, which measured intersite consistency, was significant for 20 variables. Conclusions: Managed care and fee-for-service Medicaid programs did not differ on most measures; however, a lack of sufficient power was evident for many measures. Full endorsement of managed care for vulnerable populations will require further research that assumes low penetration rates and intersite variability.

Original languageEnglish (US)
Pages (from-to)1245-1253
Number of pages9
JournalPsychiatric Services
Issue number10
StatePublished - Oct 2005
Externally publishedYes

ASJC Scopus subject areas

  • Psychiatry and Mental health


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