IMPLEMENTATION OF MEDICAID MANAGED MENTAL-HEALTH-CARE IN IOWA - PROBLEMS AND SOLUTIONS

Under the terms of a 1915(b) waiver Iowa implemented a statewide carve -out program in 1995 for the management of mental health services for Medicaid recipients by contracting with a private for-profit corporati on. In this commentary, the strategy used to develop the Medicaid mana ged care contract in Iowa is briefly summarized. Problems that were en countered in program implementation and regulatory attempts to address those issues are described. Suggestions for other states regarding th e development, implementation, and oversight of contracts for managed care so that they might be able to deliver comprehensive mental health care services with acceptable standards of care quality are offered B y including appropriate contract specifications, providing mechanisms for oversight, and enforcing standards of care in Medicaid managed car e contracts, many problems that occurred in Iowa may have been minimiz ed or avoided. This experience can provide a valuable lesson for simil ar program initiatives in other states.