Children's Behavioral Health Transition to Managed Care

Overview and Background

As part of New York State´s efforts to "conduct a fundamental restructuring of (the) Medicaid program to achieve measurable improvement in health outcomes, sustainable cost control, and a more efficient administrative structure," the Governor appointed a Medicaid Redesign Team (MRT). The MRT created several work groups to review and provide recommendations in key areas, including behavioral health (BH). The BH work group was co-chaired by Linda Gibbs, the Deputy Mayor of New York City and Michael Hogan, the former Commissioner of the New York State Office of Mental Health (OMH). The 22 members of the work group included Commissioner Arlene González Sánchez of the NYS Office of Alcoholism and Substance Abuse Services (OASAS), advocates, providers, insurers, and other stakeholders from the New York BH community. Through the work group's six meetings, a series of recommendations were adopted. The MRT adopted recommendations from its BH work group concerning the development of specialty BH managed care.

As a result of the robust public process, the State has submitted an amendment to its current 1115 waiver demonstration to enable qualified Managed Care Organizations (MCOs) throughout the State to comprehensively meet the needs of individuals with BH needs. These needs will be met through:

  • Children in Mainstream MCOs: Children's behavioral health services, including all six home and community based service (HCBS) waivers currently operated by OMH, DOH, OPWDD and the Office of Children and Family Services (OCFS), will be included in the Medicaid Managed Care benefit package.
    The goals of the various managed care models and qualification process are to improve clinical and recovery outcomes for participants with SMI and/or SUDs; reduce the growth in costs through a reduction in unnecessary emergency and inpatient care; and increase network capacity to deliver community-based recovery-oriented services and supports. To ensure Managed Care Organizations are equipped to meet the needs of the behavioral health population, the plans will be reviewed and qualified against new behavioral health specific administrative, performance, and fiscal standards. Implementation will be staggered, according to the timeline described below.

In July 2015, DOH published a Special Edition Medicaid Update on the New York State Behavioral Health Transition to Managed Care.