Florida's medicaid mental health carve-out: Lessons from the first years of implementation

Florida, like many other states, has embarked on an experiment with managed mental health care for Medicaid enrollees. Under a 1915 (b) waiver the sta te's Medicaid agency began a mental health carve-out demonstration in March 1996 in the Tampa Bay area. This qualitative case study seeks to ascertain the impact of the carve-out (and, by comparison, HMO arrangements) an the public mental health sector Findings suggest that the carve-out demonstrati on has succeeded in creating a fully integrated mental health delivery syst em with financial and administrative mechanisms that support a shared clini cal model; However; other findings raise concerns about the HMO model in te rms of stability access to care, efficiency and more generally about the sh ifting of risk and public responsibility "downstream" to private organizati ons without sufficient governmental oversight. These findings may offer gui dance for other states implementing major managed care policy initiatives f or disabled Medicaid enrollees.