Changes in access to mental health care among the poor and nonpoor: Results from the health care reform in Puerto Rico

Objectives. Health care reforms associated with managed care may adversely affect the health care safety net for disadvantaged populations. This study compared changes in health care use among poor and nonpoor individuals enr olled in managed care. Methods. Data from 3 waves of a random community sample were collected on a pproximately 3000 adults. Changes in use of mental health services were ass essed in a pretest-posttest, quasi-experimental design. Results. Managed care increased use of specialty services among the nonpoor while maintaining the same level of use for the poor in the public sector. Conclusions. Reallocation of mental health services may be a result of expa nding Medicaid eligibility.