Relative success of state-managed behavioral health care: does the financing structure play any role?

Federal Section 1915(b) and Section 1115 waivers, through the Health Care Financing Administration, are the primary modes for implementing Medicaid-managed mental health and chemical dependency services. This paper focuses on three distinct case studies of managed mental health programs in Tennessee, Massachusetts, and Hawaii. The purpose is to determine, among other design factors (such as carve-in, carve-out, and covered services) the specific roles that differences in the financing structure play in the relative success of these programs. Findings from the three distinct models should provide lessons for the impending mental health programs of other states, including those in the varying stages of implementation.