Comparing provider perceptions of access and utilization management in full-risk and no-risk medicaid programs for adults with serious mental illness

This article compares provider perceptions of access to services and utiliz ation management (UM) procedures in two Medicaid programs in the same state : a full-risk capitated managed care (MC) program and a no-risk, fee-for-se rvice (FFS) program. Survey data were obtained from 198 mental health clini cians and administrators. The only difference found between respondents in the FFS and MC sites was that outpatient providers in the MC site reported significantly lower levels of access to high-intensity services than did pr oviders in the FFS site (p < .001). Respondents in the two sites reported s imilar attitudes toward UM procedures, including a strong preference for in ternal over external UM procedures. These findings support the conclusion t hat through diffusion of UM procedures, all care in the Medicaid program fo r persons with a serious mental illness is managed, regardless of risk arra ngement. Implications for mental health services and further research are d iscussed.